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]

There is evidence of a fluid collection or hematoma along the nasal septum or in the nasal cavity.   [Yes/No]

The nasal septum is fractured.   [Yes/No]

The nasal bones are fractured.   [Yes/No]

The medial, lateral and posterior maxillary walls are fractured.   [Yes/No]

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

The alveolar ridge, premaxilla, and/or the palatine process of the maxillary bones on either side are fractured.   [Yes/No]

The hard palate is fractured.   [Yes/No]

The pterygoid processes of the sphenoid bone are fractured.   [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]

The nasolacrimal canal is fractured.   [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]

The the zygomatic arch, frontozygomatic suture or infraorbital rim are fractured.   [Yes/No]

The lateral wall of the orbit is fractured.   [Yes/No]

There is fracture of the greater or lesser wing of the sphenoid bone, optic strut and canal, or basisphenoid, in the region of the orbital apex.   [Yes/No]

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

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

The orbital apex and the superior and inferior orbital fissures are abnormal.   [Yes/No]

The extraocular muscles are swollen.   [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 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 entrapment of the muscles of mastication by fractures of the coronoid process and/or zygomatic arch.   [Yes/No]

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

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

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

The condylar head and fossa as well as the temporomandibular joint space are abnormal.   [Yes/No]

There is condylar fracture either within or outside of the joint capsule, or with or without involvement of the articular surface of the condylar head.   [Yes/No]

There is evidence of radiodense intra-articular osteochondral fragments.   [Yes/No]

There is bony injury or displacement of the external auditory canal and/or other evidence of temporal bone injury.   [Yes/No]

There are dental fractures and/or missing or displaced teeth.   [Yes/No]

The visualized portions of the cervical spine are abnormal.   [Yes/No]