IMAGING OF FACIAL SKELETAL TRAUMA Anesa engi General Hospital - - PowerPoint PPT Presentation

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imaging of facial skeletal trauma
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IMAGING OF FACIAL SKELETAL TRAUMA Anesa engi General Hospital - - PowerPoint PPT Presentation

Mar 10, 2024 368 likes •727 views

IMAGING OF FACIAL SKELETAL TRAUMA Anesa engi General Hospital Sarajevo FACIAL FRACTURES Facial fractures are commonly caused by blunt or penetrating trauma due to motor vehicle accidents, work and sport related injuries, assaults, and

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IMAGING OF FACIAL SKELETAL TRAUMA

Anesa Čengić General Hospital Sarajevo

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FACIAL FRACTURES

Facial fractures are commonly caused by blunt

  • r penetrating trauma due to motor vehicle

accidents, work and sport related injuries, assaults, and falls. Analysis

  • f

the fractured face requires a knowledge of not only normal anatomy, but also

  • f common fracture patterns in the face.
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FACIAL TRAUMA EVALUATION

  • X-ray overrated
  • Isolated nasal or zygomatic arch fx
  • Hazzy sinuses, lines of Dolan
  • CT imaging modality of choice
  • Easier to perform in multitrauma patients and

non-cooprative patients

  • If you think of injury other then simple nasal

fracture

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Examination technique

  • 0.6 mm axial multi-detector scan acquisition
  • Axial scaning from above the frontal sinus

down to below hard palate, can include mandibule if there is a clinical suspition for fracture

  • Coronal 1 mm reformats
  • Bone and soft tissue window, 3D imaging
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Aim of imaging

  • Fracture lines, Bony displacements
  • Soft tissue injuries
  • Organize by compartments or butresses
  • Categorize the fracture type
  • Intracranial complication
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Facial anatomy

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  • Buttresses are all linked either directly or through another

buttress to the cranium or cranial base as a stable reference point.

  • Buttresses

have sufficient bone thickness to accommodate metal screw fixation.

  • Transverse buttress reduction restores facial profile and

width; vertical buttress reduction restores facial height.

  • Buttress reduction establishes a functional support for the

teeth and globes.

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Frontal sinus

  • Anterior wall, Posterior wall, Both
  • Displacement and comminution

Posterior wall fracture

  • Pneumochephalus
  • Dural violation
  • Degree of bone lose
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SLIDE 11
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Nasal bone fractures

  • Most common facial fracture
  • Blunt

force applied from anterior or lateral direction

  • Fracture

extension into the nasal cartilage may disrupt the perichondrium causing sepatal hematoma

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Nasal bone fractures

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SLIDE 14
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Fractures of the naso-orbitoethmoid (NOE) complex

  • High-impact force applied anteriorly to nose
  • Severe comminution of both medial maxillary

buttresses (nasal bones and septum, ethmoid sinuses, medial

  • rbital wall)
  • Spares lateral butresses
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Markowitz / Manson classification

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SLIDE 17
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Zygomaticomaxillary complex fracture

  • quadripod fx
  • Direct traumatic blow to

malar eminence

  • Dissociation of zygomatic

bone from calvaria

  • Associated orbital injuries

33% of cases

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Medial or lateral rotation of zygomatic bone?

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ZMC FX

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Le Fort fractures

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Le Fort fractures

  • 1. Pterygoid plates (intact of fractured)
  • 2. Pterygomaxillary disjunction

Classify the fractures

I. Lateral piriform aperture II. Inferior orbital rim and zygomaticomaxillary suture

  • III. Zygomatic arch+lateral orbital wall
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Orbital „blowout“ fractures

  • Trauma caused by large object that cannot enter

the orbit

  • Orbital rim remains intact
  • Orbital wall is fractured
  • Complication: muscule herniation and entrapment, globe

injury, infraorbital nerve injury

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Mandibular fractures

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Mandibular fractures

  • Fractures occurs in multiple location
  • Ring-like structure typically produces at least

two discreate fractures

  • Plain ortopantogram should not be used as a

single modality for mandibular fractures

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SLIDE 31

Mandibular fractures

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SLIDE 32

Mandibular fractures

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SLIDE 33
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Conclusion Summary

  • CT imaging modality of choice
  • Group facial fractures into clinically relevant

patterns

  • Provide clinically relevant radiology report
  • Cooperate and discuss with surgeon