Zygomaticomaxillary complex tripod fracture

Zygomaticomaxillary complex (ZMC) fracture in 47-year-old victim of closed-fist assault. Axial bone CT (A-B), coronal bone CT (C), and 3D reconstructed CT with surface rendering (D-F) scans show the several fracture planes of the assault. There is a fracture of the anterior wall of the right maxillary sinus (white arrow, A) with resultant hematoma occupying the lumen of the sinus. Also note the contralateral displacement of the nasal septum, as well as the fracture of the lateral pterygoid plate of the sphenoid (black arrow, A). There are bilateral comminuted fractures of the nasal bones (white dashed arrows, B, F). The maxillary ZMC is fractured in three places, including 1) communited fractures of the right sphenozygomatic sutures and overhanging fragments of distracted frontozygomatic sutures in the region of the lateral orbital wall (black dashed arrow, B, white arrowhead, C, white thick arrow, D, E, F), 2) the zygomatic arch (F), and 3) inferior orbital wall with inferior extension to the right alveolar ridge (black arrowheads, C, E, F).