Zygomaticomaxillary (tripod) fracture

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)
• 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

Differential Diagnosis

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Evaluation

• CT face
• Rule-out associated ocular injuries or other trauma

Management

• Usually requires admission and surgical repair

Disposition

• Loss of vision or displacement: admit for IV antibiotics and surgery

See Also

• Maxillofacial trauma