Case 25 Answer

Everyone nailed it. We are still warming up so this is a simple ZMC fracture (aka tripod fracture as I learned it). This is comprised of:

1) zygomatic arch fx

2) lateral orbital rim fx

3) Fx of the anterior and posterior maxillary walls (including the inferior orbital floor/rim

After nasal bone fractures, these are the most common facial fracture. Often obvious on clinical exam, these are usually due to direct blunt force. Amount of depression is important. You can look for EOM entrapment but in my experience it is uncommon

http://radiopaedia.org/articles/zygomaticomaxillary-complex-fracture-1

I really like this link. It is a little old school but it provides a nice “birds eye view”  http://www.radiologymasterclass.co.uk/gallery/trauma/x-ray_spinal_1/fractures_3.html