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Zygomaticomaxillary (tripod) fracture
From WikEM
(Redirected from Tripod Fracture)
Contents
Background
- Must distinguish Zygomatic Arch Fracture from Zygomaticomaxillary (Tripod) Fracture
- Definition = fracture through:
- Inferior orbital rim
- Lateral orbital wall
- Zygomatic arch
Clinical Features
- Facial trauma (blunt, medially-directed force or high-energy decceleration)
- Normally depression of tripod (cheekbone) complex
- Lower eyelid/cheek pain, swelling, and ecchymosis
- +/- Diplopia with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma)
- +/- Trismus
- +/- Epistaxis
- +/- Paresthesias of lower lid, cheek, nose, upper lip if injury to infraorbital nerve
Differential Diagnosis
Maxillofacial Trauma
- Le Fort fractures
- Skull fracture (peds)
- Auricular hematoma
- Nasal fracture
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Dental trauma
- Mandible fracture
Orbital trauma
Acute
- Ruptured Globe^
- Corneal Abrasion
- Ocular foreign body
- Conjunctival laceration
- Caustic Keratoconjunctivitis^^
- Subconjunctival hemorrhage
- Traumatic iritis
- Traumatic hyphema
- Retinal detachment
- Retrobulbar hemorrhage/hematoma
- Traumatic mydriasis
- Orbital fracture
- Frontal sinus fracture
- Naso-ethmoid fracture
- Inferior orbial wall fracture
- Medial orbital wall fracture
Subacute/Delayed
Evaluation
- CT face
- Rule-out associated ocular injuries or other trauma (e.g. retrobulbar hematoma, ruptured globe)
Management
- OMFS/ENT consult
- Optho consult if ocular signs/symptoms
- Analgesia
- Antibiotic prophylaxis if extends into paranasal sinuses (amoxicillin, fluoroquinolone, doxycycline, or clindamycin)
- Usually requires admission and surgical repair
Disposition
- Loss of vision or displacement: admit for IV antibiotics and surgery
