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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Malocclusion with an anterior open bite

■ Pain, inability to close jaw, difficulty speaking

TREATMENT

■ Reduce dislocation in a C-shaped maneuver (downward pressure on the

back of the third molars and slight upward pressure on the symphysis of

the mandible) (see Figure 14.12).

■ Postreduction X-ray is used to rule out fracture and verify reduction.

Zygomatico-Maxillary-Orbital Complex Fracture

Tripod fractures are fractures of the zygoma (also known as cheek bone or

malar bone). The fracture results from a direct blow to the zygoma (MVC or

assault). The term tripod refers to the three fracture sites: (1) the zygomatic-

frontal suture, (2) connection to the inferior orbit floor and rim, and (3) the

zygomatic-temporal suture (zygomatic arch). See Figure 14.13.

SYMPTOMS/EXAM

■ Facial flattening and asymmetry

■ Paresthesia of cheek due to injury to the maxillary branch of the trigemi-

nal nerve (CN V)

■ Periorbital emphysema

■ Trismus or difficulty opening and closing jaw may occur due to entrapment

of the coronoid process of the mandible under a depressed zygomatic arch.

■ Diplopia in setting of concurrent orbital blowout fracture

FIGURE 14.12. Reduce a dislocated mandible by pushing inferiorly and posteriorly.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski SJ. Emergency

Medicine: A Comprehensive Study Guide, 6th ed.New York: McGraw-Hill, 2004:1476.)