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ECR 2019 / C-1598
Craniofacial trauma: Keys for the radiology report
Congress: ECR 2019
Poster No.: C-1598
Type: Educational Exhibit
Keywords: Head and neck, Trauma, Emergency, CT, Conventional radiography, Diagnostic procedure, Education, Education and training
Authors: M. Orgaz Álvarez, V. Gamero Medina; Parla, MADRID/ES
DOI:10.26044/ecr2019/C-1598

Findings and procedure details

KEYS FOR DIAGNOSE FACIAL TRAUMA

  • Look at the orbits carefully, since 60 – 70 % of all facial fractures involve the orbit in some way.
  • Know the normal anatomy (including buttresses). Ver Fig. 5 .
  • Know the most common patterns of facial fractures and look for them.
  • Bilateral symmetry can be very helpful.
  • Carefully trace along the lines of Dolan when examining the Waters view in a facial series. Ver Fig. 8 .
  • Use CT in working up facial fractures.

 

 

KEYS FOR FRONTAL SINUS FRACTURES

  • Result from high-velocity blunt trauma to the upper face.
  • Frecuently accompanied by other craniofacial fractures.
  • Pneumocephalus is an indication of severe injury and requires surgical intervention.
  • See Fig. 10 .

 

 

KEYS FOR MANDIBULAR FRACTURES

  • Remember the ring bone rule.
  • Look carefully along the cortical margin of the whole mandible for discontinuities. This may be the only sign of a fracture that you will see.
  • Also carefully examine the mandibular canal for discontinuities.
  • A fracture line entering the root of a tooth is considered an open fracture by definition.
  • See Fig. 11 , Fig. 12 and Fig. 13 .

 

 

KEYS FOR NASOSEPTAL FRACTURES

  • The most common of all facial skeletal injuries.
  • These fractures are much better seen when the film is shot with special low KVp nasal bone technique (essentially soft tissue technique).
  • The channel for the nasociliary nerve runs parallel to the bridge of the nose, while most nasal bone fractures will run perpendicular to the bridge. See Fig. 14 .
  • Remember that the humble nasal bone fracture may be associated with more extensive injuries, such as the orbital rim or floor and the ethmoid or frontal sinuses.
  • See Fig. 15 .

 

 

KEYS FOR ORBITAL FRACTURES

  • Blow-out fractures: When fractures in the orbital wall extend outward into the sinuses → enophthalmos. See Fig. 16 .
  • Blow-in fractures: When fractured bone introduces into the orbital space inhabited by the eye.
  • The orbit should be evaluated in three orthogonal planes at CT.

 

 

KEYS FOR ZMC FRACTURES

  • Multiplanar assessment is required to evaluate the four common points of failure of a “tetrapod” ZMC fracture. See Fig. 17 .
  • The zygomaticsphenoid suture is the most sensitive CT indicator of asymmetry and orbital volume changes from ZMC malalignment.
  • Failure to anticipate floor defect expansion is a major cause of late enophthalmos after ZMC reduction.

 

 

 KEYS FOR LE FORT FRACTURES

  • Le Fort I → Floating palate
  • Le Fort II → Floating maxilla
  • Le Fort III → Craniofacial dissociation.
  • The maxillary occlusion-bearing fragment is typically managed at Le Fort I.
  • Look for incomplete hairline fractures at the piriform aperture and pterygoid plates on coronal images and for retrusion and / or impaction on axial images.
  • Palatal fractures are best assessed with combined evaluation of axial and coronal images.
  • See Fig. 18 , Fig. 19 and Fig. 20 .
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