0:01

Well, without much more ado,

0:03

let's get onto the tripod fracture.

0:05

Now, the tripod fracture is also called

0:07

the zygomaticomaxillary complex fracture.

0:12

And what's curious about the tripod fracture is it goes

0:15

through four zygomatic articulations, so you think it

0:19

would be three, but we have the zygomaticomaxillary,

0:23

the zygomaticofrontal, the zygomaticotemporal,

0:26

and the zygomaticosphenoid articulations of the zygoma.

0:30

These fractures, as you can tell, are

0:32

laterally located, and they may be associated

0:35

with the Le Fort III type of fracture,

0:38

which also involves the lateral orbital wall.

0:41

That commonly is an isolated zygomatic arch

0:45

fracture, and that can be from a simple punch

0:48

to the lateral side of the face, where you can

0:51

actually get depression of the zygomatic arch.

0:54

However, more commonly, we see them as this

0:56

tripod—what I call a tripod fracture.

0:58

You may also hear the term the trimalar fracture. Some

1:03

of the pearls and what we should be looking at with

1:06

ZMC fractures—zygomatic complex fractures—is if there

1:10

is depression of the zygomatic arch, it sometimes will

1:14

lead to impaired mobility of the mandibular coronoid process.

1:20

And therefore, you'll see it as a complaint

1:23

that the patient is unable to open their mouth

1:25

completely. Beware that the orbital floor and

1:28

the orbital rim are often fractured in concert

1:31

with the ZMC fracture or the tripod fracture.

1:34

And again, that's why some people don't like

1:36

using these classifications of terms like

1:39

Le Fort fractures or NOE or ZMC fractures.

1:43

They just report the fractures independently.

1:47

Facial asymmetry and enophthalmos are complications

1:50

of the fracture because, again, when the lateral

1:54

orbital wall is involved, it can lead to the

1:57

sinking in of the orbital structures into the gaps.

2:02

Here is, diagrammatically, what we look

2:05

for as far as the various sutures that

2:10

are associated with the zygoma and the

2:13

zygomatic arch.

2:14

So here's our zygoma with attachment.

2:17

Here, you can see towards the orbit and the maxilla.

2:21

You can see it at the frontal portion, also reflecting

2:24

the lateral orbital wall, and then here in the

2:27

zygomatic arch, attaching back here to the temporal bone.

2:31

And these articulations, or these suture

2:35

regions, can also be seen on this coronal

2:37

view and pointed out for you nicely here.

2:43

Okay, so what are we looking for?

2:44

We're looking for the attachment of the

2:48

zygoma to the zygomatic arch, to the posterior

2:53

articulation here into the temporal bone.

2:58

Here, we see the involvement of the maxilla.

3:02

Here's the maxillary antrum.

3:04

Okay.

3:04

And the maxilla.

3:05

And then, you may see it at the frontal portion where

3:10

it makes the articulation with the lateral orbit.

3:13

So this piece of bone effectively is a free fragment

3:18

as it disarticulates from the frontal, maxillary,

3:21

zygomatic arch, and the temporosphenoid bone.

3:26

So this is the disarticulation of

3:29

the zygomaticomaxillary complex

3:32

that you see here.

3:35

Another example here is the typical involvement

3:39

of the lateral orbital wall, as well as the

3:43

involvement of the most posterior portion.

3:45

This is our zygomatic arch posteriorly here, and

3:50

then we have the attachment also to the maxilla.

3:55

And then, this fragment here is now effectively a free-

4:00

floating fragment as it has been

4:03

disarticulated from the various suture

4:06

connections to the other facial bones.