Zygomaticomaxillary (tripod) fracture: Difference between revisions
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==Background== | ==Background== | ||
*Must distinguish [[ | *Must distinguish zygomaticomaxillary (tripod) fracture from [[zygomatic arch fracture]] | ||
*Also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture | |||
*Definition = fracture through: | *Definition = fracture through: | ||
*#Inferior orbital rim | *#Inferior orbital rim | ||
*#Lateral orbital wall | *#Lateral orbital wall | ||
*#Zygomatic arch | *#[[Zygomatic arch fracture|Zygomatic arch]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Facial trauma (blunt, medially-directed force or high-energy decceleration) | *[[Facial trauma]] (blunt, medially-directed force or high-energy decceleration) | ||
*Normally depression of tripod (cheekbone) complex | *Normally depression of tripod (cheekbone) complex | ||
*Lower eyelid/cheek pain, swelling, and ecchymosis | *Lower eyelid/cheek pain, swelling, and ecchymosis | ||
*+/- Diplopia with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma) | *+/- [[Diplopia]] with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma) | ||
*+/- Trismus | *+/- Trismus | ||
*+/- Epistaxis | *+/- [[Epistaxis]] | ||
*+/- Paresthesias of lower lid, cheek, nose, upper lip if injury to infraorbital nerve | *+/- [[Paresthesias]] of lower lid, cheek, nose, upper lip if injury to infraorbital nerve | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*CT face | [[File:PMC4145677 eplasty14ic27 fig1.png|thumb|CT scan demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection (top left), displacement at the sphenozygomatic suture (top right), zygomaticomaxillary buttress (bottom right), with minimal orbital floor displacement (bottom left).]] | ||
* | [[File:PMC4772575 AMS-5-262-g001.png|thumb|Left zygomaticomaxillary complex fracture with associated orbital fracture.]] | ||
*CT sinus/face | |||
*Ocular exam to evaluate for concomitant orbital injury (e.g. [[retrobulbar hematoma]], [[ruptured globe]]) | |||
==Management== | ==Management== | ||
* | *[[Analgesia]] | ||
*Surgical consult | |||
*Optho consult if ocular signs/symptoms | *Optho consult if ocular signs/symptoms | ||
*Antibiotic prophylaxis if extends into paranasal sinuses ([[amoxicillin-clavulanate]], [[doxycycline]], or [[clindamycin]]) | |||
*Antibiotic prophylaxis if extends into paranasal sinuses ([[amoxicillin]] | |||
**For non-operative fractures into sinus, may not need prophylactic antibiotics <ref>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.</ref> | **For non-operative fractures into sinus, may not need prophylactic antibiotics <ref>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.</ref> | ||
**No difference in soft tissue infections in three groups (no prophylaxis, short course, long course) | |||
*Usually requires | *Usually requires surgical repair | ||
==Disposition== | ==Disposition== | ||
* | *Based on discussion with surgery | ||
**Generally may be discharged with outpatient surgical followup in 1 week | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Latest revision as of 13:34, 25 September 2021
Background
- Must distinguish zygomaticomaxillary (tripod) fracture from zygomatic arch fracture
- Also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar 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.