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. The complex anatomy and fractures of the facial bones are shown extremely well by CT, and soft tissue complications can be evaluated to a far greater degree with CT.
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The Tripod Fracture
Facial and Mandibular Fractures
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:. If needed, closed or open reduction methods can be performed with the goal of treatment being preservation of normal facial structure, sensory function, globe position and mastication functionality. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
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Zygomaticomaxillary complex fracture
The zygomaticomaxillary complex ZMC plays a key role in the structure, function, and esthetic appearance of the facial skeleton. They are the second most common facial bone fracture after nasal bone injuries. 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. A 4-year retrospective review of all patients treated with ZMC fractures at oral and maxillofacial surgery department, sree balaji dental college and hospital was performed. Computed tomography scans were reviewed.
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.