Severe Tripod

Moderate and severe tripod fractures frequently extend to the infraorbital foramen and can result in infraorbital nerve injury. Moderate and severe tripod injuries are also seen in association with orbital floor or blowout fractures.

In severe tripod fractures, the zygoma fragment can be displaced posteriorly to the coronoid process, often preventing jaw closure. Severe tripod fractures may also have a fracture line extending posteriorly, disrupting the temporomandibular joint.

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Images show a severe tripod fracture on the right. There is widening of all of the zygomatic sutures with fragmentation of the zygomatic arch. Extension of the zygomaticomaxillary fracture through the orbital floor, lamina papyracea, and lateral wall of the maxillary sinus can be appreciated. A fracture of the medial wall of the maxillary sinus and multiple minimally displaced nasal bone fractures are seen.

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Axial image demonstrates fragmentation and depression of the right zygomatic arch. A minimally displaced fracture through the zygomaticotemporal suture can be appreciated. Comminued fractures of the anterior and posterolateral walls of the right maxillary sinus are seen.

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A more cephalad axial image demonstrates widening of the zygomaticomaxillary suture on the right. A minimally displaced fracture through the right orbital floor is seen. Fragmentation of the posterolateral wall of the right maxillary sinus can be appreciated.

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A more cephalad axial image demonstrates fragmentation at the right frontozygomatic suture.

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Coronal image demonstrates widening of the right frontozygomatic and zygomaticomaxillary sutures. A fracture through the right zygomatic arch can be appreciated.