Zygomaticomaxillary (tripod) fracture

Background

• Must distinguish Zygomatic Arch Fracture from Zygomaticomaxillary (Tripod) 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

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

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
    • No difference in soft tissue infections in three groups (no prophylaxis, short course, long course)
• Usually requires admission and surgical repair

Disposition

• Loss of vision or displacement: admit for IV antibiotics and surgery

See Also

• Maxillofacial trauma