It is 1 am on a Saturday night. You are about to see a 30 year old man who has been assaulted at a pub. The left side of the patient’s face is swollen and the facial x-rays are as follows. What can you see?

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The OM (occipitomental) view shows:

• irregularity over the centre of the left orbital floor
• slight widening of the left frontozygomatic suture
• fracture of lateral orbital wall
• maybe fluid (blood in the context of trauma) in the left maxillary antrum

The OM (30) view shows:

• left zygomatic arch fracture
• there is also step deformity (inwards) of the lateral wall of the maxillary antrum

This patient has a combination of injuries called the Tripod Fracture which essentially consists of ipsilateral triad of:

• zygoma fracture (break through the orbital floor and lateral wall of antrum)
• zygomatic arch fracture
• widening of frontozygomatic suture

Here are the CT images showing the left infraorbital fracture and fluid in the left maxiallry antrum clearly:

This patient needs referral to maxillofacial surgeons from the ED.

Thanks to Dr. Michael Lovegrove for the images.

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