Zygomaticomaxillary (tripod) fracture

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

Evaluation
  • 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 [1]
    • 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

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.
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