Difference between revisions of "Zygomaticomaxillary (tripod) fracture"
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==Background== | ==Background== | ||
| − | *Must distinguish [[ | + | *Must distinguish zygomaticomaxillary (tripod) fracture from [[zygomatic arch fracture]] |
*Definition = fracture through: | *Definition = fracture through: | ||
*#Inferior orbital rim | *#Inferior orbital rim | ||
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**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) | ***No difference in soft tissue infections in three groups (no prophylaxis, short course, long course) | ||
| − | *Usually requires | + | *Usually requires surgical repair |
==Disposition== | ==Disposition== | ||
Revision as of 17:29, 19 August 2018
Contents
Background
- Must distinguish zygomaticomaxillary (tripod) fracture from zygomatic arch 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)
- 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)
- For non-operative fractures into sinus, may not need prophylactic antibiotics [1]
- Usually requires surgical repair
Disposition
- Loss of vision or displacement: admit for IV antibiotics and surgery
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.