fractures of face

1. TRIPOD FRACTURE
Archana Subbaraj

2. TRIPOD FRACTURE
• THIS IS ALSO CALLED AS FRACTURE OF ZYGOMA.
• THIS IS THE ZYGOMATICOMAXILLARY COMPLEX FRACTURE.
• THIS IS THE SECOND MOST FREQUENTLY FRACTURED BONE AFTER
NASAL BONES.
• CAUSE:DIRECT TRAUMA
• LOWER SEGMENT OF ZYGOMA IS PUSHED MEDIALLY AND
POSTERIORLY RESULTING IN FLATTENING OF THE MALAR
PROMINENCE AND A STEP DEFORMITY AT THE INFRAORBITAL
MARGIN.
• ZYGOMA IS SEPARATED AT ITS THREE PROCESSES.

3. • FRACTURE LINE PASSES THROUGH
ZYGOMATICOFRONTAL SUTURE,ORBITAL FRACTURE,INFRAORBITAL
MARGIN AND
FORAMEN,ANTERIOR WALL OF MAXILLARY SINUS AND THE
ZYGOMATICOTEMPORAL SUTURE.
• ORBITAL CONTENTS MAY HERNIATE INTO THE MAXILLARY SINUS.

5. • TRIPOD FRACTURE CONSIST OF FRACTURES THROUGH:
1)ZYGOMATIC ARCH
2)ZYGOMATICOFRONTAL SUTURE
3)INFERIOR ORBITAL RIM AND FLOOR

7. CLINICAL FEATURES
1. FLATTENING OF MALAR PROMINENCE.
2. STEP DEFORMITY OF INFRAORBITAL MARGIN.
3. ANAESTHESIA IN THE DISTRIBUTION OF INFRAORBITAL NERVE.
4. TRIMUS,DUE TO DEPRESSION OF ZYGOMA ON THE UNDERLYING
CORONOID PROCESS.
5. OBLIQUE PALPEBRAL FISSURE,DUE TO THE DISPLACEMENT OF
LATERAL PALPEBRAL LIGAMENT.
6. RESTRICTED OCULAR MOVEMENTS,DUE TO ENTRAPMENT OF
INFERIOR RECTUS MUSCLE.IT MAY CAUSE DIPLOPIA.
7. PERIORBITAL EMPHYSEMA,DUE TO ESCAPE OF AIR FROM THE
MAXILLARY SINUS ON NOSE BLOWING.

8. Other features
• PAIN
• PERIORBITAL OEDEMA
• PERIORBITAL ECCHYMOSIS AND ECCHYMOSIS OF MAXILLARY BUCCAL
SULCUS.
• FLATTENING OVER ARCH.
• UNEQUAL PUPILLARY LEVELS.
• ENOPHTHALMOS
• SUBCONJUNCTIVAL HAEMORRHAGE.
• CREPITATION
• EPISTAXIS
• PARAESTHESIA OF CHEEK
• DEFORMITY OF ZYGOMATIC BUTTRESS

9. DIAGNOSIS
• X-RAY[WATER’S VIEW OR EXAGGERATED WATER’S VIEW]
=SHOWS FRACTURE AND DISPLACEMENT THE BEST.
• MAXILLARY SINUS SHOW CLOUDING OF DUE TO PRESENCE OF
BLOOD.
• COMMINUTION WITH DEPRESSION OF ORBITAL FLOOR AND
HERNIATION OF ORBITAL CONTENTS CAN’T BE SEEN ON PLAIN X-RAY.
• CT SCAN OF ORBITAL WILL BE MORE USEFUL.

10. TREATMENT
• DISPLACED FRACTURE ONLY REQUIRES TREATMENT.
1. OPEN REDUCTION
2. INTERNAL WIRE FIXATION-MOST COMMON.
TRANSANTRAL APPROACH –LESS FAVOURABLE.

12. • MOST OF THE PATIENTS WERE TREATED WITH ONE POINT FIXATION.
• WITH THE ZYGOMATICOMAXILLARY BUTTRESS BEING THE MOST
POPULAR FIXATION POINT.(90%)
• ZM BUTTRESS AND FRONTOZYGOMATIC SUTURE WERE COMMONEST
CHOICES FOR TWO POINT FIXATION.(70%)
• BUCCAL SULCUS INCISION IS USED FOR ZM ACCESS IN ALL CASES.
• FOR FZ ACCESS, UPPER BLEPHAROPLASTY INCISION WAS THE MOST
COMMON.(56%)
• FOR INFRA ORBITAL MARGIN ACCESS,TRANSCONJUNCTIVAL INCISION
WAS THE MOST COMMON.(75%)
• THERE WAS NO SIGNIFICANT ASSOCIATION BETWEEN NUMBER OF
FIXATION POINTS AND PRESENCE OF ASSOCIATED INJURIES,IMAPACT
OF INJURY OR TIME OPERATION.

13. POST OPERATIVE COMPLICATIONS
• THERE WERE NO POST OPERATIVE COMPLICATIONS.