Post-Surgery Pain and Nerve Recovery After Zygomatic Fracture

Six months after surgery for a zygomatic bone fracture, there is pain at the site of the bone screws?

Hello Doctor, last September I accidentally missed a step while helping my family move, and I fell face-first while carrying a heavy object, resulting in a zygomatic bone fracture.
At the time, my face swelled up immediately, and I went to the hospital three or four days later.
I vaguely remember the doctor saying that the fracture was quite severe, involving three pieces of bone, including the orbital bone and zygomatic bone, with comminuted fractures.
I underwent surgery the next day, and there were no significant symptoms postoperatively.

Now, six months later, I have suddenly started experiencing intermittent sharp pain at the site of the zygomatic bone surgery, occurring about three to four times a day.
It's not very painful, but I can definitely feel it.
I recall that absorbable bone screws were used during the surgery.

I would like to ask if this intermittent sharp pain is normal.
Additionally, I would like to know the typical recovery period for facial nerves, as my face was very numb after the surgery, but it improved significantly within one to two weeks.
However, my lip is slightly tilted towards the side where the surgery was performed.
Is this a sign that the nerve has not fully recovered, or is it a residual effect of the surgery? I appreciate your clarification, thank you.

Danxin de xiao gao yi, 10~19 year old female. Ask Date: 2022/06/14

Dr. Chen Yongxue reply Orthopedics

It is possible that the nerves are being compressed by scar tissue.
Please follow up with your attending physician in the outpatient clinic.

Reply Date: 2022/06/14

More Info

After a zygomatic fracture surgery, experiencing pain and nerve recovery issues can be quite common, especially given the complexity of facial structures and the potential for nerve involvement during the surgical procedure. Your symptoms of intermittent pain and the sensation of "twitching" or "pulling" in the area of the fracture site may be attributed to several factors, including nerve regeneration, scar tissue formation, and the healing process of the bone itself.

Understanding Your Symptoms
1. Intermittent Pain: The pain you are experiencing, described as "抽痛" (twitching pain), can be a result of several factors. After surgery, the body undergoes a healing process that can involve inflammation and the formation of scar tissue. This scar tissue can sometimes irritate nearby nerves, leading to sensations of pain or discomfort. Additionally, the nerves that were affected during the surgery may still be in the process of healing, which can lead to sporadic pain as they regenerate.

2. Nerve Recovery: The recovery of facial nerves can vary significantly from person to person. In general, the initial recovery of sensation can occur within a few weeks to months post-surgery, but full recovery may take longer. It is not uncommon for patients to experience residual symptoms, such as weakness or asymmetry, for several months after surgery. The fact that you noticed improvement in the first few weeks is a positive sign, but the lingering asymmetry in your smile could indicate that the nerve is still healing or that there may be some degree of permanent change due to the injury or surgery.

Recommendations for Management
1. Follow-Up with Your Surgeon: It is crucial to maintain regular follow-ups with your surgeon or a specialist in facial trauma. They can assess the healing process and determine if any further intervention is necessary. They may also recommend imaging studies to evaluate the bone healing and any potential complications.

2. Physical Therapy: Engaging in physical therapy focused on facial rehabilitation can be beneficial. A therapist can provide exercises to help improve muscle function and symmetry, which may assist in addressing the asymmetry you are experiencing.

3. Pain Management: For managing pain, over-the-counter pain relievers such as ibuprofen or acetaminophen can be helpful. If the pain persists or worsens, your doctor may prescribe stronger medications or recommend other pain management strategies, including nerve blocks or topical treatments.

4. Monitor Symptoms: Keep a detailed record of your symptoms, including the frequency and intensity of the pain, any changes in sensation, and any other related symptoms. This information can be invaluable for your healthcare provider in determining the best course of action.

5. Patience with Recovery: Nerve recovery can be a slow process, and it is essential to be patient. While some patients may experience significant improvement within a few months, others may take longer. It is important to manage expectations and understand that some residual symptoms may persist.

Conclusion
In summary, the symptoms you are experiencing post-zigomatic fracture surgery are not uncommon, and they may be related to the healing process of both the bone and the nerves involved. Regular follow-up with your healthcare provider, engaging in physical therapy, and managing pain effectively are key steps in your recovery. If you have concerns about your symptoms or if they worsen, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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