Difference between revisions of "Zygomaticomaxillary (tripod) fracture"

(Clinical Features)
Line 7: Line 7:
  
 
==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

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

Evaluation

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

See Also

References