Interactive Transcript
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Well, without much more ado,
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let's get onto the tripod fracture.
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Now, the tripod fracture is also called
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the zygomaticomaxillary complex fracture.
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And what's curious about the tripod fracture is it goes
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through four zygomatic articulations, so you think it
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would be three, but we have the zygomaticomaxillary,
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the zygomaticofrontal, the zygomaticotemporal,
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and the zygomaticosphenoid articulations of the zygoma.
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These fractures, as you can tell, are
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laterally located, and they may be associated
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with the Le Fort III type of fracture,
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which also involves the lateral orbital wall.
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That commonly is an isolated zygomatic arch
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fracture, and that can be from a simple punch
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to the lateral side of the face, where you can
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actually get depression of the zygomatic arch.
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However, more commonly, we see them as this
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tripod—what I call a tripod fracture.
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You may also hear the term the trimalar fracture. Some
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of the pearls and what we should be looking at with
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ZMC fractures—zygomatic complex fractures—is if there
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is depression of the zygomatic arch, it sometimes will
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lead to impaired mobility of the mandibular coronoid process.
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And therefore, you'll see it as a complaint
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that the patient is unable to open their mouth
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completely. Beware that the orbital floor and
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the orbital rim are often fractured in concert
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with the ZMC fracture or the tripod fracture.
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And again, that's why some people don't like
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using these classifications of terms like
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Le Fort fractures or NOE or ZMC fractures.
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They just report the fractures independently.
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Facial asymmetry and enophthalmos are complications
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of the fracture because, again, when the lateral
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orbital wall is involved, it can lead to the
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sinking in of the orbital structures into the gaps.
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Here is, diagrammatically, what we look
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for as far as the various sutures that
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are associated with the zygoma and the
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zygomatic arch.
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So here's our zygoma with attachment.
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Here, you can see towards the orbit and the maxilla.
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You can see it at the frontal portion, also reflecting
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the lateral orbital wall, and then here in the
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zygomatic arch, attaching back here to the temporal bone.
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And these articulations, or these suture
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regions, can also be seen on this coronal
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view and pointed out for you nicely here.
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Okay, so what are we looking for?
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We're looking for the attachment of the
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zygoma to the zygomatic arch, to the posterior
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articulation here into the temporal bone.
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Here, we see the involvement of the maxilla.
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Here's the maxillary antrum.
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Okay.
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And the maxilla.
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And then, you may see it at the frontal portion where
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it makes the articulation with the lateral orbit.
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So this piece of bone effectively is a free fragment
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as it disarticulates from the frontal, maxillary,
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zygomatic arch, and the temporosphenoid bone.
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So this is the disarticulation of
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the zygomaticomaxillary complex
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that you see here.
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Another example here is the typical involvement
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of the lateral orbital wall, as well as the
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involvement of the most posterior portion.
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This is our zygomatic arch posteriorly here, and
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then we have the attachment also to the maxilla.
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And then, this fragment here is now effectively a free-
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floating fragment as it has been
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disarticulated from the various suture
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connections to the other facial bones.
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