Tripod fracture is the name given to the zygomaticomaxillary complex fracture. However, interestingly the tripod fractures are now known as the quadramalar fracture or quadripod fracture. They are known as quadramalar fracture because they involve four components. The four features of the face which are involved in quadramalar fractures are the lateral orbital wall, the Zygomatic arch, separation of the zygoma and the maxilla and the orbital floor near the infraorbital canal.
The tripod fracture is caused by a direct impact on the malar eminence. The orbital floors and the lateral walls are made by a pair of zygoma each having two attachments to the maxilla and two attachments to the cranium. The name given to these complexes is the zygomaticomaxillary complex. The vertical maxillary bone and the lateral wall have the frontozygomatic sutures and the zygomaticomaxillary, and the upper and transverse maxillary bone has the zygomaticotemporal and zygomaticomaxillary.
The discontinued term “tripod fracture” referred to the buttresses, but the term did not comprise of the posterior relationship between the sphenoid bone at the zygomaticosphenoid suture and the zygoma.
The Zygomatic arch and complex are vital components for healthy functioning of the face. Studies have revealed that Zygomatic arch fractures are one of the most commonly occurring fractures in men and women alike. The higher number of Zygomatic arch fractures can also be owed to high number of cases of domestic violence and road accidents. While commonly only adults are more susceptible to automobile accidents and violence, children suffer from Zygomatic arch fracture due falls, sports mishaps etc. though there has been a decrease in the number of tripod fractures due to increasing use of seat belts and airbags, the people suffering from the tripod fractures is still alarmingly high.
The ZMC acts as natural reinforcement structure for the face and its position is significant to the aesthetics of the face. It gives definition to the midfacial region. Because of the complexity of the structure whenever a zygomaticomaxillary arch fracture occurs multiple fractures occur at once. Fractures may lead to a condition known as the trismus. Because of, a person is unable to completely open his/her mouth. In a person who has trismus the jaw opening could be between 20-30 mm where in ideal condition it should be 40-50mm. Trismus is mostly. Sometimes temporary and may be caused due to multiple reasons. The temporomandibular joint may also get affected due to tripod fracture and may acquire a disorder known as the TMJ disorder. The joint of the jaw is known as the temporomandibular joint. This joint is between the mandible and the upper temporal bone. TMJ works as a hinge between skull and jaw. Damage to temporomandibular joint may cause focal pain. Difficulty in chewing from both or one side, pain in jaw or pain in the TMJ on both sides are some of the signs of the TMJ disorder. TMJ disorder is commonly seen in people who have the habit of grinding or clenching their teeth. Temporomandibular joint disorders can be treated well with home remedies also.
The treatment plan is decided completely by the surgeon and he is responsible for deciding which approach to take. Different approaches for the treatment may require help from different sub- specialties such as oculoplastic surgery, plastic surgery etc. In zygomaticomaxillary arch fractures, the fracture of the socket around the eye may adversely affect the vision. Therefore, to assess the condition of the optical nerves, several tests are run. Remodeling of the skull may be required in case of multiple fractures. Since children are not fully developed, the skull remodeling in them poses different set of challenges. The approach taken for remodeling of skull in children is done keeping in mind the growth of skull and brain that is yet to take place.
A suitable treatment plan is the first step in correct treatment and fixation of tripod fractures. In case of tripod fractures, the aim of the treatment is to restore the facial features to their pre trauma condition. One very important thing to remember is that the patient should be taken for the treatment quickly and only a specialist with good reputation and excellent skills should do the surgery. An experienced and talented surgeon only cannot only repair the tripod fractures but also ensure that the post trauma complications are kept to a minimum. Generally, tripod fractures are caused by heavy trauma therefore the cases of tripod fractures are considered to be grave emergencies. The patient should be rushed to the best facility which is available in the shortest time to ensure the best treatment is given. If the time lapse between the accident and the treatment for tripod fractures is short, the treatment can be done more effectively with better results. The post operative complications can also be minimized if the treatment is done in time.