Age: 46
Sex: Male
Indication: Trauma
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Case #6
Findings
- Right Le Fort type I, II, and III, zygomaticomaxillary complex (ZMC), and nasoorbitoethmoid (NOE) fractures with a comminuted fracture of the right zygomatic arch, blowout fractures of the right medial, lateral, and inferior orbital walls, fractures of all walls of the right maxillary sinus, bilateral nasal arch fractures, fractures throughout the right ethmoid air cells extending superiorly through the cribriform plate, fracture of the nasal septum, and fractures of the right pterygoid plates. Fractures involve the nasolacrimal canal and infraorbital foramen
- Herniation of orbital and retroantral fat through the right orbital floor blowout fracture and posterior maxillary wall fracture, respectively, with contour irregularity of the right medial and inferior rectus muscles. Right retrobulbar hemorrhage and gas without proptosis
- Acute depressed right parietal fracture with anterior continuation as a comminuted fracture of the greater wing of the right sphenoid with a comminuted fracture of the lateral wall of the right sphenoid sinus extending to involve the right carotid canal, right foramen rotundum, and right inferior orbital foramen. There is also continuation through the right frontal bone with involvement of the frontal sinus and into the lateral wall and roof of the right orbit
- Acute nondisplaced left parietal fracture extending into the left frontal bone, involving the left frontal sinus and extending into the lateral wall and roof of the left orbit. Left retrobulbar hemorrhage and gas without proptosis
- Bilateral diastasis of the zygomaticofrontal sutures
- Acute minimally displaced fracture of the right hemimandible at the base of the coronoid process extending into the condylar neck
- Bifrontal extraaxial hematomas and pneumocephalus
- Extensive hemosinus
- Extensive facial soft tissue swelling and subcutaneous emphysema
Diagnosis
- Extensive facial smash injury, skull fractures, extraaxial hematomas
Sample Report
Extensive facial smash injury with right Le Fort type I, II, and III, zygomaticomaxillary complex (ZMC), and nasoorbitoethmoid (NOE) fractures. Notably, fractures involve the nasolacrimal canal and infraorbital foramen and extend superiorly through the cribriform plate on the right. There is bilateral diastasis of the zygomaticofrontal sutures.
Partially imaged acute depressed right parietal fracture with anterior continuation as a comminuted fracture of the greater wing of the right sphenoid with a comminuted fracture of the lateral wall of the right sphenoid sinus extending to involve the right carotid canal, right foramen rotundum, and right inferior orbital foramen. There is also continuation through the right frontal bone with involvement of the frontal sinus and into the lateral wall and roof of the right orbit. Additionally, there is an acute nondisplaced left parietal fracture extending into the left frontal bone, involving the left frontal sinus and extending into the lateral wall and roof of the left orbit. Bifrontal extraaxial hematomas and pneumocephalus, which can be further assessed on dedicated head CT imaging.
Herniation of orbital and retroantral fat through a right orbital floor blowout fracture and posterior maxillary wall fracture, respectively, with contour irregularity of the right medial and inferior rectus muscles. Recommend correlation with clinical signs of extraocular muscle entrapment.
Bilateral retrobulbar hemorrhage and gas without proptosis. Globes are intact.
Acute minimally displaced fracture of the right hemimandible at the base of the coronoid process extending into the condylar neck. Temporomandibular joints remain located.
Extensive hemosinus.
Extensive facial soft tissue swelling and subcutaneous emphysema.
Discussion
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