Facial Fracture Midface 2
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0078-Facial Fracture Midface 2
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CA0078-Facial Fracture Midface 2
Case ReportHistory
Exam
Prior Study
Findings
Facial and Scalp Soft Tissues and Airway
There is swelling of the peri-orbital soft tissues with presence of gas on the right, and to a lesser extent on the left. There is also swelling of the soft tissues in the pre-maxillary region with presence of extensive gas in the right buccal space.
Intracranial
There is minimal pneumocephalus in the right olfactory fossa. There is no evidence of intracranial injury.
Midface - Maxillary Region
There is a fluid collection or hematoma along the nasal septum or in the nasal cavity. The nasal septum is fractured.
There are bilateral fractures of the frontal processes of the maxilla on both sides and the medial, lateral and posterior maxillary walls. The hard palate is not fractured. The pterygoid processes of the sphenoid bone are fractured bilaterally.
Fronto-Naso-Ethmoidal Complex
There is a comminuted nasal bone fracture displaced to the right as well as a fracture of the frontal processes of the maxilla on both sides and the medial wall of the orbit is fractured on the right. The intercanthal distance is not increased. There is a fracture of the nasolacrimal canal on both sides.
The olfactory fossa and the cribriform plate are subtly disrupted on the right where there is some intracranial gas.
There is a comminuted and depressed fracture of the outer table of the right frontal sinus with the inner table fractured at the mesial junction of the frontal and ethmoid bones near the expected position of the anterior ethmoid artery.
Zygomatico-Orbital Region and Globes
There is a fracture of the zygomatic arch on both sides. The fracture is nondisplaced on the left and extends into the root of the zygoma on the right. There is a fracture through the left frontozygomatic suture and both infraorbital rims. There is no entrapment of the muscles of mastication by fractures of the coronoid process and/or zygomatic arch.
There is a fracture of the lateral wall of both orbits. There are also comminuted fractures of both orbital floors with herniation of a relatively high volume of orbital fat into the fracture sites. The anterior medial right orbital roof is fractured at its junction with the naso- frontal complex.
There is no fracture of the greater or lesser wing of the sphenoid bone, optic strut and canal, or basisphenoid, in the region of the orbital apex.
The circumferential extraconal and the intraconal orbital fat are edematous on the right. There is no evidence of a subperiosteal hematoma along the medial wall, roof or floor of the orbit. The orbital apex and the superior and inferior orbital fissures are normal.
The medial and lateral rectus muscles are swollen on the right but there is no evidence of muscular entrapment on either side.
Proptosis is present on the right; however, there is no evidence of significant tension orbit. There is evidence of swelling at the junction of the optic sheath and nerve on the right so that injury to the optic nerve sheath complex cannot be excluded on the right.
Mandible and Temporomandibular Joints
There is no significant injury of the mandible or temporomandibular joints.
Dentition
There are no dental fractures and/or missing or displaced teeth.
Cervical Spine
The visualized portions of the cervical spine are normal.
Other Findings
Impression
2- Complex craniofacial injury with components of orbital zygomatic, LeFort 3 type midface injury and high-volume orbital blow out fractures with possible injury to the junction of the optic nerve and sheath - extent described above.
3-Fronto- naso-ethmoidal complex fractures and midface fractures, extending into the anterior cribriform plate on the right - extent described above.
