Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 5/31/2005

Question
-------------------------
Followup To
Question -

Thank you so much for your thorough and informative response.  I'm hoping to find a maxillofacial surgeon to consult with in my area but I'm not sure where to begin.  I live in the Los Angeles area and I was wondering if you would have any suggestions.  I was also wondering how I should address my situation when making an appointment as I'm sure my insurance would not cover the cost of a consultation for something that they'd consider cosmetic.

Thanks again.

Hi -

Over five years ago I fell and hit my right cheekbone.  I did not seek medical attention at the time as I did not think that I had sustained an injury.  As time has passed however I notice a significant change in my facial symmetry and my right cheekbone appears flattened. (I also have problems with my right jaw joint and have sought TMJ treatment in the past.)

Is it possible that I fractured my cheekbone, and if so could this be corrected years later.  I am not sure who to consult with as I don't know if this falls under maxillofacial surgery or plastic surery or if insurance would even begin to cover an injury sustained years ago.

Thanks for your time
Answer -
Kate  -  its sounds like you sustained a trimalar fracture.  The bony suture lines of the cheek bone when separated by force produce this type of fracture.  One the surture lines is on a bone that provides the roof for the temporomandibular joint (TMJ). The poor position of healing has altered the muscles that attach to the bone and have probably produced many of the symptoms associated.

After a 5 year wait, the surgery to rebreak the bones and position the trimalar bone is very extensive.  If the problem were cosmetic only, artificial bone can be placed to build up the cheek bone and make it look symmetrical with the other side.  The problem appears, with you, to include functional alteration with the TMJ situation.  You may require treatment of the TMJ and cosmetics concurrently.

My suggestion is to find a local board certified oral and maxillofacial surgeon in your area, preferrably one associated with a large medical center.  This type of doctor is trained in the treatment of both the cosmetic and functional problems.

I wish you well.  If you have any further questions do not hesitate to contact me again.  Please let me know what the surgeon sayss

Answer
Kate -  You are correct to a point about the insurance for cosmetic problems, but you also have a functional problem associated with the old fracture.  In this situation insurance coverage is easily argued and should cover most if not all the necessary treatment.

I am away from home now and I am unable to give you specifics for the doctors in your area, but The UCLA Medical Center has an excellent program with outstanding doctors.  I would try there first and if you are not satisfied get back to me and I'll give you a name.