Age: 54
Sex: Male
Indication: Blunt trauma
Save ("V")
Case #15
Findings
- Extensive facial crush injury with posterior impaction of the midface
- Acute right Le Fort I, II, and III and left Le Fort I and II fractures with highly comminuted nasal arch fractures, fractures of all walls of both orbits (with the exception of the left lateral orbital wall, which is intact) and maxillary sinuses, anterior and posterior right zygomatic arch fractures, fracture of the nasal septum, and bilateral pterygoid fractures. Fracture through the hard palate involving the socket of the right lateral maxillary incisor
- Bilateral nasoorbitoethmoid fractures including the above discussed nasal arch and medial wall of maxillary sinus fractures in addition to extensive fractures throughout the ethmoid sinuses and bilateral fractures extending through the cribriform plate
- Comminuted and mildly displaced fractures involving the anterior and posterior walls of both frontal sinuses
- Right medial and inferior orbital wall blowout fractures with deviation of the inferior rectus muscle into the orbital floor fracture defect. Extraconal hematoma along the orbital roof
- Left inferior orbital wall blowout fracture with inferior deviation of the inferior rectus muscle and a small amount of extraconal orbital fat herniating into the maxillary sinus. Trace extraconal hemorrhage along the orbital roof
- Tiny calcific density along the right margin of the mandible
- Extensive facial soft tissue swelling with multiple sites of intermixed soft tissue gas
- Partially imaged nasoenteric tube
Diagnosis
- Right Le Fort I, II, and III fractures
- Left Le Fort I and II fractures
- Bilateral orbital blowout fractures with inferior rectus muscle deviation/herniation
Sample Report
Extensive facial crush injury with posterior impaction of the midface and the following dominant fracture patterns and key findings:
Right Le Fort I, II, and III fractures with anterior and posterior right zygomatic arch fractures.
Left Le Fort I and II fractures without evidence of zygomatic fracture.
Bilateral nasoorbitoethmoid fractures extending superiorly through the cribriform plate, which places the patient at risk for CSF leak.
Bilateral orbital blowout fractures with inferior herniation of the inferior rectus muscle on the right and inferior deviation of the inferior rectus muscle on the left. Recommend correlation with clinical signs of extraocular muscle entrapment.
Small amount of bilateral retrobulbar extraconal hemorrhage without proptosis or evidence of traumatic globe injury.
Tiny calcific density along the right margin of the mandible may represent a tiny chip/avulsion fracture without additional evidence of mandibular fracture.
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