Zygomaticomaxillary (tripod) fracture

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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 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

  • OMFS/ENT consult
  • Optho consult if ocular signs/symptoms
  • Analgesia
  • Antibiotic prophylaxis if extends into paranasal sinuses (amoxicillin, fluoroquinolone, doxycycline, or clindamycin)
  • Usually requires admission and surgical repair

Disposition

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

See Also

References