There is localized edema, hematoma or abscess within in the facial or scalp soft tissues, SMAS, infratemporal fossa, masticator space or oral cavity.   [Yes/No]

There is evidence of gas or a foreign body at a possible fracture site, indicative of an open or penetrating injury.   [Yes/No]

There is soft tissue swelling suggesting injury to the parotid or submandibular glands.   [Yes/No]

The upper airway is significantly narrowed or obstructed.   [Yes/No]

There is subperiosteal, epidural or subdural hematoma and/or pneumocephalus along the boney walls of the anterior or middle cranial fossa or elsewhere.   [Yes/No]

There is subarachnoid bleeding.   [Yes/No]

There is evidence of parenchymal brain injury.   [Yes/No]

The preseptal soft tissues including the lacrimal gland and sac are normal.   [Yes/No]

There is evidence of a foreign body at the fracture site, indicative of penetrating injury.    [Yes/No]

There is evidence of blood products in the paranasal sinuses.   [Yes/No]

There is evidence of a subperiosteal hematoma along the medial or lateral wall, roof or floor of the orbit.    [Yes/No]

The circumferential extraconal and the intraconal orbital fat are infiltrated.   [Yes/No]

There is evidence of herniated intra-orbital fat.   [Yes/No]

The extraocular muscles are swollen, infiltrated or herniated into a fracture site.   [Yes/No]

The soft tissues of the orbital apex and the superior and inferior orbital fissures appear abnormal.   [Yes/No]

The orbital veins appear abnormal.   [Yes/No]

There is evidence of bony injury along the walls and/or floor of the orbit.   [Yes/No]

The supraorbital and infraorbital rims and orbital process of the zygoma and/or frontozygomatic suture are fractured.   [Yes/No]

There is bony injury of the orbital roof or related portions of the frontal bone.   [Yes/No]

The infraorbital canal is fractured.   [Yes/No]

The zygomatic arch is fractured.   [Yes/No]

The optic strut and remainder of the optic canal and adjacent body and lesser wings of the sphenoid bone are fractured.   [Yes/No]

There is entrapment of the muscles of mastication by fractures of the coronoid process and/or zygomatic arch.   [Yes/No]

There is a fracture of the greater or lesser wing of the sphenoid bone or basisphenoid.
  [Yes/No]

Proptosis is present.   [Yes/No]

The optic nerve has a stretched appearance.   [Yes/No]

The posterior aspect of the globe is tented.   [Yes/No]

There are signs of a decompressed globe.   [Yes/No]

The lens is in normal position on either side.   [Yes/No]

There is evident general optic sheath swelling or swelling at the junction of the globe and sheath to suggest an optic sheath hematoma.   [Yes/No]

There is evident subretinal, subchoroidal or intravitreous hemorrhage.   [Yes/No]

There is bony injury to the nasolacrimal canal.   [Yes/No]

The nasolacrimal sac appears to be intact.   [Yes/No]

The mesial naso-orbito-ethmoid complex is fractured. Specifically, there is bony injury of the nasal bones or the frontal process of the maxilla and the medial walls of the orbit are abnormal.   [Yes/No]

The intercanthal distance is increased.   [Yes/No]

There is injury of the ethmoid complex. Specifically, the ethmoid roof, olfactory fossa and the cribriform plate are fractured and/or significantly dehiscent.   [Yes/No]

The frontal bone and frontal sinus inner and outer tables are fractured.   [Yes/No]

There is bony injury of the body, alveolar ridge, premaxilla, the infraorbital rim, the palatine or the frontal process of the maxillary bones on either side.   [Yes/No]

The pterygoid processes of the sphenoid bone are fractured.   [Yes/No]

There is bony injury or displacement of the body, angle, ramus, alveolar ridge, condylar coronoid process and parasymphyseal or symphyseal region of the mandible.
  [Yes/No]

The visualized portions of the cervical spine are abnormal for the patient’s age.   [Yes/No]