View source for Zygomaticomaxillary (tripod) fracture

==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:
*#Inferior orbital rim
*#Lateral orbital wall
*#[[Zygomatic arch fracture|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 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==
*Based on discussion with surgery
**Generally may be discharged with outpatient surgical followup in 1 week

==See Also==
*[[Maxillofacial trauma]]

==References==
<references/>

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