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: |
| − | + | **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== | ==Differential Diagnosis== | ||
{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
| + | |||
| + | ==Evaluation== | ||
| + | *CT sinus/face | ||
| + | *Ocular exam to evaluate for concomitant orbital injury (e.g. [[retrobulbar hematoma]], [[ruptured globe]]) | ||
| + | |||
| + | ==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 <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) | ||
| + | *Usually requires surgical repair | ||
==Disposition== | ==Disposition== | ||
| − | * | + | *Based on discussion with surgery |
| + | **Generally may be discharged with outpatient surgical followup in 1 week | ||
==See Also== | ==See Also== | ||
| − | *[[Maxillofacial | + | *[[Maxillofacial trauma]] |
| − | |||
| − | == | + | ==References== |
| − | + | <references/> | |
[[Category:ENT]] | [[Category:ENT]] | ||
| − | [[Category: | + | [[Category:Orthopedics]] |
[[Category:Trauma]] | [[Category:Trauma]] | ||
Latest revision as of 23:09, 30 September 2019
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 sinus/face
- Ocular exam to evaluate for concomitant orbital injury (e.g. retrobulbar hematoma, ruptured globe)
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
- ↑ 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.