Zygomaticomaxillary (tripod) fracture

Background

• Must distinguish Zygomatic Arch Fracture from Zygomaticomaxillary (Tripod) Fracture
• Definition = fracture through:
  • Inferior orbital rim
  • Lateral orbital wall
  • Zygomatic arch

Clinical Features

• Facial trauma (blunt, medially-directed force)
• 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

Differential Diagnosis

Maxillofacial Trauma

• Auricular hematoma
• Dental trauma
• Head trauma (main)
• Le Fort fractures
• Mandible fracture
• Nasal fracture
• Nasal septal hematoma
• Orbital trauma
  • Globe rupture
• Skull fracture
  • Basilar skull fracture
  • Skull fracture (peds)
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture

Evaluation

• CT face
• Rule-out associated ocular injuries or other trauma

Management

• Usually requires admission and surgical repair

Disposition

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

See Also

• Maxillofacial trauma