Zygomaticomaxillary complex (ZMC) fractures, also known as tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. They comprise fractures of the:

  • zygomatic arch
  • inferior orbital rim, and anterior and posterior maxillary sinus walls
  • lateral orbital rim


They can account for ~40% of midface fractures. They are the second most common facial bone fracture after nasal bone fractures.


The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. Additionally, the fracture components may result in impingement of the temporalis muscle, trismus (difficulty with mastication) and may compromise the infraorbital foramen/nerve resulting in hypoesthesia within its sensory distribution.

Radiographic features

On radiographic evaluation, typically with dedicated CT imaging with multiplanar reformats, the following three fracture components are generally identified:

Treatment and prognosis

If needed, closed or open reduction methods can be performed with the goal of treatment being preservation of normal facial structure, sensory function, globe position and mastication functionality.

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