Zygomaticomaxillary (tripod) fracture

Background

  • Must distinguish zygomaticomaxillary (tripod) fracture from zygomatic arch 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

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)
  • Usually requires surgical repair

Disposition

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

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.