Zygomaticomaxillary (tripod) fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Facial trauma (blunt, medially-directed force) | *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 | |||
*+/- Paresthesias of lower lid, cheek, nose, upper lip if injury to infraorbital nerve | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
*CT face | *CT face | ||
*Rule-out associated ocular injuries or other trauma | *Rule-out associated ocular injuries or other trauma (e.g. [[retrobulbar hematoma]], [[ruptured globe]]) | ||
==Management== | ==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 | *Usually requires admission and surgical repair | ||
Revision as of 13:54, 21 September 2016
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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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