Scribd Logo
Upload

Welcome to Scribd!

  • 116 views

    Tripod Fracture

    Uploaded by

    kenn Parrocho
    The patient is a 45-year-old man who was in a vehicular accident where he was slammed face-first into the side of a tricycle. He presented with facial deformity, trismus, and asymmetry. Imaging showed he had a tripod or orbitozygomaticomaxillary fracture on the left side. He underwent open reduction internal fixation surgery to repair the fracture using multiple approaches. The tripod or trimalar fracture involves fractures of the orbital rim, zygomatic arch, and zygomaticomaxillary buttress, which can cause issues like trismus if not properly addressed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Tripod Fracture

    Uploaded by

    kenn Parrocho
    116 views45 pages
    The patient is a 45-year-old man who was in a vehicular accident where he was slammed face-first into the side of a tricycle. He presented with facial deformity, trismus, and asymmetry. Imaging showed he had a tripod or orbitozygomaticomaxillary fracture on the left side. He underwent open reduction internal fixation surgery to repair the fracture using multiple approaches. The tripod or trimalar fracture involves fractures of the orbital rim, zygomatic arch, and zygomaticomaxillary buttress, which can cause issues like trismus if not properly addressed.

    Original Description:

    free

    Original Title

    Tripod fracture

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The patient is a 45-year-old man who was in a vehicular accident where he was slammed face-first into the side of a tricycle. He presented with facial deformity, trismus, and asymmetry. Imaging showed he had a tripod or orbitozygomaticomaxillary fracture on the left side. He underwent open reduction internal fixation surgery to repair the fracture using multiple approaches. The tripod or trimalar fracture involves fractures of the orbital rim, zygomatic arch, and zygomaticomaxillary buttress, which can cause issues like trismus if not properly addressed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    116 views45 pages

    Tripod Fracture

    Uploaded by

    kenn Parrocho
    The patient is a 45-year-old man who was in a vehicular accident where he was slammed face-first into the side of a tricycle. He presented with facial deformity, trismus, and asymmetry. Imaging showed he had a tripod or orbitozygomaticomaxillary fracture on the left side. He underwent open reduction internal fixation surgery to repair the fracture using multiple approaches. The tripod or trimalar fracture involves fractures of the orbital rim, zygomatic arch, and zygomaticomaxillary buttress, which can cause issues like trismus if not properly addressed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 45
    At a glance
    Powered by AI
    The patient was involved in a vehicular accident which resulted in an orbitozygomaticomaxillary fracture of the left side. Open reduction internal fixation was done via multiple surgical approaches to repair the fracture.

    An orbitozygomaticomaxillary fracture, also known as a trimalar or tripod fracture.

    Facial deformity and trismus (difficulty opening the mouth).

    Tripod fracture

    The Case
    Visitacion, R.
    45 year old
    Male
    Single
    Sipalay City
    Pedicab driver
    Admitted: November 15, 2015

    Chief complaint

    Facial deformity and trismus

    History of Present Illness

    NOI: Vehicular Accident


    TOI: 4 pm
    POI: Sipalay City
    DOI: October 25, 2015

    Patient was a passenger in a tricycle.


    Driver suddenly hit the brakes
    Patient was slammed on the side car face
    first obtaining multiple injuries on the face

    Review of Systems

    (-)
    (-)
    (-)
    (-)
    (-)

    loss of consciousness
    vomiting
    blurring of vision (-) diplopia
    difficulty breathing
    difficulty swallowing

    Past Medical History


    No history of previous
    hospitalizations
    No previous surgeries
    No known food and drug allergies

    Family History

    (+) Hypertension
    (-) Diabetes
    (-) Bronchial Asthma
    (-) Malignancy

    Personal and Social History

    (-) smoking
    (-) alcoholic beverage drinker

    Physical Examination

    TENDERNESS
    STEP DEFORMITY
    LOSS OF MALAR
    PROMINENCE
    ASYMMETRY

    Physical Examination

    Intact EOMS

    MOUTH OPENING: up to 2
    FINGER BREATHS
    (+) TRISMUS
    (-) DRAWERS SIGN

    Intact pearl gray


    tympanic membrane
    No discharges
    No erythema

    Nasal septum midline


    No polyp
    No discharges
    No nasal congestion

    Diagnostics

    Diagnostics

    Admitting Impression

    Orbitozygomaticomaxillary fracture,
    left secondary to Vehicular Accident

    OR done

    Open Reduction Internal Fixation of


    Orbitozygomaticomaxillary fracture via
    multiple approach (Subciliary, brow
    and Caldwell Luc Incision)

    Post Op

    Post Op

    Post Op

    Case Discussion
    Tripod Fracture

    Zygomatic fractures
    Zygoma- very strong
    bone that is along the
    suture lines
    (zygomaticofrontal and
    zygomaticotemporal)
    when fractures do
    occur
    Most common cause is
    trauma

    Trimalar or Tripod fracture


    Orbito-zygomatic
    fracture:
    Frontozygomatic
    Zygomatic arch
    Infraorbital rim
    Zygomaticomaxillary

    Pathophysiology
    Direct blow to the malar
    eminence.
    The fracture components
    may result inimpingement
    of the temporalis muscle,
    trismus(difficulty with
    mastication)andmay
    compromise the
    infraorbital foramen/nerve
    = hypesthesia

    Zygomatic Fracture
    Zygomaticomaxillary
    buttress
    Most important buttress
    from the standpoint of
    strength and stability
    during mastication
    As a general principle,
    alignment of the zygoma
    must be confirmed in at
    least 3 areas and fixation in
    at least two areas

    Zygoma fractures
    a. Palpable deformity (step)
    at the infraorbital rim
    b. Diplopia upon upward gaze
    c. Hypesthesia of the cheek
    d. Flattening of the lateral
    aspect of the cheek
    e. Periorbital ecchymosis
    f. Inferior displacement of
    the ocular globe

    X-Ray
    Waters View

    Waters view

    X-Ray
    Submentovertical
    view

    Management
    Medical
    - Analgesia
    - Preop and postop antibiotics
    - Soft Diet

    Management
    Infraciliary or
    midcrease incision
    rim fracture
    Brow incision
    zygomatic frontal
    fracture
    Gingivobuccal
    incision maxillaryzygomatic buttress
    fracture

    Management
    Gilles approach: 1 cm above the
    hairline through the temporalis fascia
    The fracture is simply lifted up into
    position

    A temporal incision is made. Care is taken to


    avoid the superficial temporal artery.

    The dissection continues through the subcutaneous


    tissue and superficial temporal fascia down to the deep
    portion of the deep temporal fascia.

    This fascia is then incised to expose


    the temporalis muscle

    An instrument is inserted deep to the temporalis fascia and superficial


    to the temporalis muscle. Using a back-and-forth motion the instrument
    is advanced until it is medial to the depressed zygomatic arch

    A Rowe zygomatic elevator is inserted just deep to the


    depressed zygomatic arch and an outward force is applied

    Prognosis
    In general, the long-term prognosis
    after repair of zygomaticomaxillary
    complex (ZMC) fractures is very good.

    You might also like