Zygomaticomaxillary (tripod) fracture: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:PMC4772575 AMS-5-262-g001.png|thumb|Left zygomaticomaxillary complex fracture with associated orbital fracture.]] | |||
*CT sinus/face | *CT sinus/face | ||
*Ocular exam to evaluate for concomitant orbital injury (e.g. [[retrobulbar hematoma]], [[ruptured globe]]) | *Ocular exam to evaluate for concomitant orbital injury (e.g. [[retrobulbar hematoma]], [[ruptured globe]]) | ||
Revision as of 13:10, 25 September 2021
Background
- Must distinguish zygomaticomaxillary (tripod) fracture from zygomatic arch 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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- CT sinus/face
- Ocular exam to evaluate for concomitant orbital injury (e.g. retrobulbar hematoma, ruptured globe)
Management
- Analgesia
- Surgical consult
- Optho consult if ocular signs/symptoms
- Antibiotic prophylaxis if extends into paranasal sinuses (amoxicillin-clavulanate, doxycycline, or clindamycin)
- For non-operative fractures into sinus, may not need prophylactic antibiotics [1]
- No difference in soft tissue infections in three groups (no prophylaxis, short course, long course)
- Usually requires surgical repair
Disposition
- Based on discussion with surgery
- Generally may be discharged with outpatient surgical followup in 1 week
See Also
References
- ↑ Malekpour, M., Bridgham, K., Neuhaus, N., Widom, K., Rapp, M., Leonard, D., … Wild, J. (2016). Utility of Prophylactic Antibiotics in Nonoperative Facial Fractures. The Journal of Craniofacial Surgery, 27(7), 1677–1680.