Difference between revisions of "Zygomaticomaxillary (tripod) fracture"

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==Background==
 
==Background==
*Must distinguish [[Zygomatic Arch Fracture]] from Zygomaticomaxillary (Tripod) Fracture
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*Must distinguish zygomaticomaxillary (tripod) fracture from [[zygomatic arch fracture]]
**Tripod fx = fx of zygomatic arch, lat and inf orbital rims, lat wall of maxillary sinus
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*Definition = fracture through:
 +
**Inferior orbital rim
 +
**Lateral orbital wall
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**Zygomatic arch
  
==Diagnosis==
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==Clinical Features==
*Fx through:
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*[[Facial trauma]] (blunt, medially-directed force or high-energy decceleration)
**1. inferior orbital rim
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*Normally depression of tripod (cheekbone) complex
**2. lateral orbital wall
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*Lower eyelid/cheek pain, swelling, and ecchymosis
**3. zygomatic arch
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*+/- [[Diplopia]] with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma)
*Must r/o associated ocular injuries
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*+/- Trismus
*Usually requires admission and surgical repair
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*+/- [[Epistaxis]]
 +
*+/- [[Paresthesias]] of lower lid, cheek, nose, upper lip if injury to infraorbital nerve
 +
 +
==Differential Diagnosis==
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{{Maxillofacial trauma DDX}}
 +
 
 +
==Evaluation==
 +
*CT sinus/face
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*Ocular exam to evaluate for concomitant orbital injury (e.g. [[retrobulbar hematoma]], [[ruptured globe]])
 +
 
 +
==Management==
 +
*[[Analgesia]]
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*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==
*Loss of vision or displacement: admit for IV abx and surg
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*Based on discussion with surgery
 +
**Generally may be discharged with outpatient surgical followup in 1 week
  
 
==See Also==
 
==See Also==
*[[Maxillofacial Trauma]]
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*[[Maxillofacial trauma]]
*[[Zygomatic Arch Fracture]]
 
  
==Source==
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==References==
Tintinalli's
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<references/>
  
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[[Category:ENT]]
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[[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.