Zygomaticomaxillary (tripod) fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Facial trauma (blunt, medially-directed force or high-energy decceleration) | *[[Facial trauma]] (blunt, medially-directed force or high-energy decceleration) | ||
*Normally depression of tripod (cheekbone) complex | *Normally depression of tripod (cheekbone) complex | ||
*Lower eyelid/cheek pain, swelling, and ecchymosis | *Lower eyelid/cheek pain, swelling, and ecchymosis | ||
*+/- Diplopia with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma) | *+/- [[Diplopia]] with upward gaze (due to extraocular muscle contusion/entrapment, orbital hematoma) | ||
*+/- Trismus | *+/- Trismus | ||
*+/- Epistaxis | *+/- [[Epistaxis]] | ||
*+/- Paresthesias of lower lid, cheek, nose, upper lip if injury to infraorbital nerve | *+/- [[Paresthesias]] of lower lid, cheek, nose, upper lip if injury to infraorbital nerve | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*Analgesia | *[[Analgesia]] | ||
*OMFS/ENT consult | *OMFS/ENT consult | ||
*Optho consult if ocular signs/symptoms | *Optho consult if ocular signs/symptoms | ||
Revision as of 03:52, 24 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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- CT face
- Rule-out associated ocular injuries or other trauma (e.g. retrobulbar hematoma, ruptured globe)
Management
- Analgesia
- OMFS/ENT consult
- Optho consult if ocular signs/symptoms
- Antibiotic prophylaxis if extends into paranasal sinuses (amoxicillin, fluoroquinolone, 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)
- For non-operative fractures into sinus, may not need prophylactic antibiotics [1]
- Usually requires surgical repair
Disposition
- Loss of vision or displacement: admit for IV antibiotics and surgery
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.