Difference between revisions of "Zygomaticomaxillary (tripod) fracture"
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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}} | ||
| Line 18: | Line 20: | ||
==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
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
- Auricular hematoma
- Dental trauma
- Head trauma (main)
- Le Fort fractures
- Mandible fracture
- Nasal fracture
- Nasal septal hematoma
- Orbital trauma
- Skull fracture
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
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