There is localized edema, hematoma or abscess within in the periauricular, other 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 evidence of extracranial gas or a foreign body at a possible fracture site.   [Yes/No]

There is a calvarial fracture.   [Yes/No]

There is a fracture of the squamous portion of the temporal bone.   [Yes/No]

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

There is subarachnoid blood.   [Yes/No]

There is parenchymal brain injury, brain herniation and/or hydrocephalus.   [Yes/No]

The external auditory canal shows abnormal soft tissue thickening.   [Yes/No]

External auditory canal is fractured.   [Yes/No]

There is middle ear or mastoid mucosal disease/fluid.   [Yes/No]

The mastoid septae are disrupted.   [Yes/No]

The roof of the mastoid and/or middle ear is fractured.   [Yes/No]

A possible meningocele and/or encephalocele or CSF leak is present.   [Yes/No]

The sigmoid plate of the mastoid is fractured.   [Yes/No]

The ossicles, in particular the incus long process, the incudostapedial joint and stapes are fractured or dislocated.   [Yes/No]

The facial canal including the labyrinthine, tympanic and descending portions and nerve are fractured.   [Yes/No]

The inner ear including the lateral semicircular canals, vestibule and/or cochlea is fractured or otherwise abnormal.   [Yes/No]

There is air within the membranous labyrinth.   [Yes/No]

There is petrous apex fracture involving the IAC (and possibly injuring the 7th and 8th nerve), carotid canal and/or Eustachian tube.   [Yes/No]

There is a fracture crossing the transverse sinus.   [Yes/No]

There is a fracture or diastasis of the occipital-mastoid suture.   [Yes/No]

There is subperiosteal, epidural or subdural hematoma along the roof of the mastoid or middle ear or the superior and posterior (intracranial) surfaces of the petrous portion of the temporal bone.   [Yes/No]

The external auditory canal shows abnormal soft tissue thickening.   [Yes/No]

External auditory canal is fractured.   [Yes/No]

There is middle ear or mastoid mucosal disease/fluid.   [Yes/No]

The mastoid septae are disrupted.   [Yes/No]

The roof of the mastoid and/or middle ear is fractured.   [Yes/No]

A possible meningocele and/or encephalocele or CSF leak is present.   [Yes/No]

The sigmoid plate of the mastoid is fractured.   [Yes/No]

The ossicles, in particular the incus long process, the incudostapedial joint and stapes are fractured or dislocated.   [Yes/No]

The facial canal including the labyrinthine, tympanic and descending portions and nerve are fractured.   [Yes/No]

The inner ear including the lateral semicircular canals, vestibule and/or cochlea is fractured or otherwise abnormal.   [Yes/No]

There is air within the membranous labyrinth.   [Yes/No]

There is petrous apex fracture involving the IAC (and possibly injuring the 7th and 8th nerve), carotid canal and/or Eustachian tube.   [Yes/No]

There is a fracture crossing the transverse sinus.   [Yes/No]

There is a fracture or diastasis of the occipital-mastoid suture.   [Yes/No]

There is subperiosteal, epidural or subdural hematoma along the roof of the mastoid or middle ear or the superior and posterior (intracranial) surfaces of the petrous portion of the temporal bone.   [Yes/No]

There is evidence of a midface injury.   [Yes/No]

There is injury of the fronto-nasal- 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 zygomatic arch, frontozygomatic suture or infraorbital rim or lateral wall of the orbit are 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 including that of the orbital apex are edematous or otherwise abnormal.   [Yes/No]

There is evidence of tension orbit.   [Yes/No]

There is evident subretinal, subchoroidal or intravitreous hemorrhage.   [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 any part of the of the mandible including the condylar head and fossa.   [Yes/No]

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

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