Head and neck, Trauma, Emergency, CT, Conventional radiography, Diagnostic procedure, Education, Education and training
M. Orgaz Álvarez, V. Gamero Medina; Parla, MADRID/ES
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 .