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They comprise fractures of the:. They are the second most common facial bone fracture after nasal bone fractures. The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. On radiographic evaluation, typically with dedicated CT imaging with multiplanar reformats, the following three fracture components are generally identified:.
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Zygomaticomaxillary complex fracture
The Tripod Fracture | The Trauma Pro
The tripod fracture officially known as the zygomaticomaxillary complex fracture, and sometimes called a malar fracture is the most common one seen after trauma. Fundamentally, the zygoma is separated from the rest of the face in a tripod fracture. As you might imagine tripod fracture , there are three components to this fracture. The first is a fracture through the zygomatic arch 1. Next, the fracture extends across the floor of the orbit and includes the maxillary sinus 2. Finally, the fracture includes the lateral orbital rim and wall 3.
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Zygomaticomaxillary (tripod) fracture
The zygomaticomaxillary complex fracture , also known as a quadripod fracture , quadramalar fracture , and formerly referred to as a tripod fracture or trimalar fracture , has four components: the lateral orbital wall at either the zygomaticofrontal suture superiorly along the wall or zygomaticosphenoid suture inferiorly , separation of the maxilla and zygoma along the anterior maxilla near the zygomaticomaxillary suture , the zygomatic arch , and the orbital floor near the infraorbital canal. On physical exam, the fracture appears as a loss of cheek projection with increased width of the face. In most cases, there is loss of sensation in the cheek and upper lip due to infraorbital nerve injury. Facial bruising, periorbital ecchymosis, soft tissue gas, swelling, trismus , altered mastication , diplopia , and ophthalmoplegia are other indirect features of the injury.
The bones of the skull and face collectively make up the most complex area of skeletal real estate in the body. Analysis of the fractured face requires a knowledge of not only normal anatomy, but also of common fracture patterns in the face. Although they represent serious injuries, the workup and treatment of facial fractures is often properly delayed until more pressing problems have been addressed, such as the establishment of an adequate airway, hemodynamic stabilization, and the evaluation and treatment of other more serious injuries of the head, chest and skeleton. Once these problems have been managed, it is time to work up facial fractures. At our institution, high resolution CT is currently the imaging procedure of choice for most facial fractures.