Tripod fracture
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Transcript of Tripod fracture
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8/18/2019 Tripod fracture
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Tripod fracture
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Chief co!plaint
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'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
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123 Malignancy
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Personal and Social (istory
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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.