اعوجاج الحاجز الانفي وتضخم غضاريف ‏الانف

History: 

The patient had road traffic accident and came to emergency department and general condition evaluated. Glascow coma scale was 14 and cervical vertebre were normal after performing lateral cervical x ray. No other body injures.

Examination: 

General examination, patient was fully conscious well oriented , blood pressure 130 / 70 and pulse 86 and normal temperature. Color was normal.

Local examination, there were edema and ecchymosis in the right eye and zygoma. By palpation there were a step in the lower orbital margin and a step in lateral orbital rim and trismus. The malar eminence was depressed and flatten in comparison with other side.eye movement normal and visual acuity was good and no entrapment

Investigation: 

CT maxillofacial axial and coronal and 3D was done and showed fracture zygoma tripode fracture and now called quadripode fracture. The site of fractures included the zygomatico-maxillary buttress and fronto-zygomatic buttress and inferior orbital rim and the junction of greater wing of sphenoid with the lateral orbital wall.

Treatment: 

The patient was prepared for maxillofacial operation. Under general anesthesia, the approach to the fracture of the inferior orbital rim was through subciliary incision and elevation of skin muscle flap and elevation of periosteum from the floor. The approach to the zygomatico- maxillary buttress was through oral sublabial incision and elevation of the periosteum. The approach to the fronto- zygomatic buttress was through extention of the subciliary incision lateraly and with the RSTL resting skin tension line. After exposure of all fracture sites, reduction of the depressed zygoma done with zygomatic hook and fixation of three point of the fracture, the inferior orbital rim and lateral orbital rim by microplates and screws of titanum, the zygomatico-maxillary buttress by miniplates and screws of titaneum. The closure of the wound after doing facial suspension and subcutaneus stitches.