Tripod fracture

8/18/2019 Tripod fracture

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Tripod fracture


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Chief co!plaint

•

'acial defor!ity and tris!us


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(istory of Present )llness

• #*)" Vehicular ccident

• T*)" 4 p!

• P*)" Sipalay City

• +*)" *ctober %5, %&$5

• Patient as a passenger in a tricycle.

•+river suddenly hit the bra-es

• Patient as sla!!ed on the side car facerst / obtaining !ultiple in0uries on the face


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Revie of Syste!s

• 123 loss of consciousness

• 123 vo!iting

•

123 blurring of vision 123 diplopia• 123 diculty breathing

• 123 diculty salloing


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Past Medical (istory

• #o history of previoushospitaliations

• #o previous surgeries

• #o -non food and drug allergies


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'a!ily (istory

•

163 (ypertension• 123 +iabetes

• 123 7ronchial sth!a

•

123 Malignancy


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Personal and Social (istory

•

123 s!o-ing• 123 alcoholic beverage drin-er


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Physical 89a!ination

ST8P +8'*RM)T:

;*SS *' M;R

PR*M)#8#C8

S:MM8TR:

T8#+8R#8SS


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Physical 89a!ination

M*


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)ntact pearl grayty!panic !e!brane

#o discharges#o erythe!a

#asal septu! !idline

#o polyp#o discharges#o nasal congestion


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+iagnostics


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+iagnostics


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d!itting )!pression

*rbitoygo!atico!a9illary fracture,left secondary to Vehicular ccident


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*R done

*pen Reduction )nternal 'i9ation of*rbitoygo!atico!a9illary fracture via!ultiple approach 1Subciliary, bro

and Caldell ;uc )ncision3


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Post *p


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Post *p


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Post *p


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Case +iscussion

Tripod 'racture


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@ygo!atic fractures

@ygo!a2 very strongbone that is along thesuture lines1ygo!aticofrontal and

ygo!aticote!poral3hen fractures dooccur

Most co!!on cause is

trauma


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Tri!alar or Tripod fracture

*rbito2ygo!aticfracture"

• 'ronto2ygo!atic

• @ygo!atic arch

• )nfraorbital ri!

• @ygo!atico2!a9illary


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Pathophysiology

• +irect blo to the !alare!inence.

• The fracture co!ponents!ay result in i!pinge!ent

of the te!poralis !uscle,

• trismus 1diculty ith!astication3 and !ayco!pro!ise the

infraorbital fora!enBnerve hypesthesia


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@ygo!atic 'racture

@ygo!atico!a9illarybuttress

• Most i!portant buttressfro! the standpoint of

strength and stabilityduring !astication

s a general principle,

align!ent of the ygo!a!ust be conr!ed in atleast D areas and 9ation inat least to areas


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@ygo!a fractures

a. Palpable defor!ity 1step3at the infraorbital ri!

b. +iplopia upon upard gae

c. (ypesthesia of the chee-

d. 'lattening of the lateralaspect of the chee-

e. Periorbital ecchy!osis

f. )nferior displace!ent ofthe ocular globe


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E2Ray

• >ater?s Vie


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>ater?s vie


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E2Ray

Sub!entoverticalvie


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Manage!ent

Medical

- nalgesia

- Preop and postop antibiotics

- Soft +iet


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Manage!ent

Infraciliary ormidcrease incision /ri! fracture

–

7ro incision /ygo!atic frontalfracture

– =ingivobuccal

incision /!a9illary2ygo!atic buttressfracture


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Manage!ent

Gilles approach" $ c! above thehairline through the te!poralis fascia

• The fracture is si!ply lifted up intoposition


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te!poral incision is !ade. Care is ta-en toavoid the supercial te!poral artery.


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The dissection continues through the subcutaneoustissue and supercial te!poral fascia don to the deepportion of the deep te!poral fascia.


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This fascia is then incised to e9posethe te!poralis !uscle


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n instru!ent is inserted deep to the te!poralis fascia and supercialto the te!poralis !uscle.


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Roe ygo!atic elevator is inserted 0ust deep to thedepressed ygo!atic arch and an outard force is applied


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Prognosis

)n general, the long2ter! prognosisafter repair of ygo!atico!a9illaryco!ple9 1@MC3 fractures is very good.

Documents

Tripod fracture