Difference between revisions of "Zygomaticomaxillary (tripod) fracture"

(Background)
(Management)
 
(4 intermediate revisions by 3 users not shown)
Line 1: Line 1:
 
==Background==
 
==Background==
*Must distinguish [[Zygomatic Arch Fracture]] from Zygomaticomaxillary (Tripod) Fracture
+
*Must distinguish zygomaticomaxillary (tripod) fracture from [[zygomatic arch fracture]]
 
*Definition = fracture through:
 
*Definition = fracture through:
*#Inferior orbital rim
+
**Inferior orbital rim
*#Lateral orbital wall
+
**Lateral orbital wall
*#Zygomatic arch
+
**Zygomatic arch
  
 
==Clinical Features==
 
==Clinical Features==
*Facial trauma (blunt, medially-directed force or high-energy decceleration)  
+
*[[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
+
*+/- [[Epistaxis]]
*+/- Paresthesias of lower lid, cheek, nose, upper lip if injury to infraorbital nerve
+
*+/- [[Paresthesias]] of lower lid, cheek, nose, upper lip if injury to infraorbital nerve
 
   
 
   
 
==Differential Diagnosis==
 
==Differential Diagnosis==
Line 19: Line 19:
  
 
==Evaluation==
 
==Evaluation==
*CT face
+
*CT sinus/face
*Rule-out associated ocular injuries or other trauma (e.g. [[retrobulbar hematoma]], [[ruptured globe]])
+
*Ocular exam to evaluate for concomitant orbital injury (e.g. [[retrobulbar hematoma]], [[ruptured globe]])
  
 
==Management==
 
==Management==
*OMFS/ENT consult
+
*[[Analgesia]]
 +
*Surgical consult
 
*Optho consult if ocular signs/symptoms
 
*Optho consult if ocular signs/symptoms
*Analgesia
+
*Antibiotic prophylaxis if extends into paranasal sinuses ([[amoxicillin-clavulanate]], [[doxycycline]], or [[clindamycin]])
*Antibiotic prophylaxis if extends into paranasal sinuses ([[amoxicillin]], fluoroquinolone, [[doxycycline]], or [[clindamycin]])
 
 
**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 admission and surgical repair
+
*Usually requires surgical repair
  
 
==Disposition==
 
==Disposition==
*Loss of vision or displacement: admit for IV antibiotics and surgery
+
*Based on discussion with surgery
 +
**Generally may be discharged with outpatient surgical followup in 1 week
  
 
==See Also==
 
==See Also==
Line 39: Line 40:
 
==References==
 
==References==
 
<references/>
 
<references/>
 
  
 
[[Category:ENT]]
 
[[Category:ENT]]
 
[[Category:Orthopedics]]
 
[[Category:Orthopedics]]
 
[[Category:Trauma]]
 
[[Category:Trauma]]

Latest revision as of 23:09, 30 September 2019

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

Evaluation

Management

  • Analgesia
  • Surgical consult
  • Optho consult if ocular signs/symptoms
  • Antibiotic prophylaxis if extends into paranasal sinuses (amoxicillin-clavulanate, 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)
  • Usually requires surgical repair

Disposition

  • Based on discussion with surgery
    • Generally may be discharged with outpatient surgical followup in 1 week

See Also

References

  1. 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.