Zygomaticomaxillary (tripod) fracture: Difference between revisions

 
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==Background==
==Background==
*Must distinguish [[Zygomatic Arch Fracture]] from Zygomaticomaxillary (Tripod) Fracture
*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
*Also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture
*Definition = fracture through:
*#Inferior orbital rim
*#Lateral orbital wall
*#[[Zygomatic arch fracture|Zygomatic arch]]


==Diagnosis==
==Clinical Features==
*Fx through:
*[[Facial trauma]] (blunt, medially-directed force or high-energy decceleration)
**1. inferior orbital rim
*Normally depression of tripod (cheekbone) complex
**2. lateral orbital wall
*Lower eyelid/cheek pain, swelling, and ecchymosis
**3. zygomatic arch
*+/- [[Diplopia]] with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma)
*Must r/o associated ocular injuries
*+/- Trismus
*Usually requires admission and surgical repair
*+/- [[Epistaxis]]
*+/- [[Paresthesias]] of lower lid, cheek, nose, upper lip if injury to infraorbital nerve
==Differential Diagnosis==
{{Maxillofacial trauma DDX}}
 
==Evaluation==
[[File:PMC4145677 eplasty14ic27 fig1.png|thumb|CT scan demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection (top left), displacement at the sphenozygomatic suture (top right), zygomaticomaxillary buttress (bottom right), with minimal orbital floor displacement (bottom left).]]
[[File:PMC4772575 AMS-5-262-g001.png|thumb|Left zygomaticomaxillary complex fracture with associated orbital fracture.]]
*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==
*Loss of vision or displacement: admit for IV abx and surg
*Based on discussion with surgery
**Generally may be discharged with outpatient surgical followup in 1 week


==See Also==
==See Also==
*[[Maxillofacial Trauma]]
*[[Maxillofacial trauma]]
*[[Zygomatic Arch Fracture]]


==Source==
==References==
Tintinalli's
<references/>


[[Category:ENT]]
[[Category:Orthopedics]]
[[Category:Trauma]]
[[Category:Trauma]]

Latest revision as of 13:34, 25 September 2021

Background

  • Must distinguish zygomaticomaxillary (tripod) fracture from zygomatic arch fracture
  • Also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture
  • Definition = fracture through:
    1. Inferior orbital rim
    2. Lateral orbital wall
    3. 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

CT scan demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection (top left), displacement at the sphenozygomatic suture (top right), zygomaticomaxillary buttress (bottom right), with minimal orbital floor displacement (bottom left).
Left zygomaticomaxillary complex fracture with associated orbital fracture.

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.