0:01

So we're going to move from French with the Le Fort

0:04

fractures and move to a little bit of Italian

0:07

with the Capo de Tutti fractures.

0:10

These are the big fractures that you shouldn't miss.

0:13

Those are fractures that can lead to CSF leaks because in

0:17

addition to having potentially intracranial hypotension,

0:21

you have the possibility of meningitis as the fracture

0:25

will communicate with the subarachnoid space.

0:27

And these involve generally the ethmoid sinuses,

0:30

the temporal bone and the sphenoid sinus.

0:32

Then we have fractures that can lead to pseudoaneurysms.

0:35

These are important fractures to note.

0:37

Most commonly, I see,

0:39

are the ones that involve the sphenoid sinus walls which

0:42

communicate with the carotid artery walls, either

0:46

in its petrous segment or its cavernous segment.

0:50

And to a lesser extent,

0:51

you see it with the lesser wing of the sphenoid

0:54

and that is at the optic canal.

0:56

And then we have fractures that can potentially

0:59

disrupt the venous sinuses.

1:00

And these generally are temporal bone and occipital bone

1:03

fractures which can lead to transverse sinus thrombosis

1:07

or rupture. And in the parasagittal location,

1:11

you may affect the superior sagittal sinus.

1:13

In general,

1:15

temporal bone fractures are ones you don't want to miss.

1:17

And sometimes I find the temporal bone fractures while

1:21

I'm looking at the cervical spine thin section images,

1:26

when they get as high as the temporal bones,

1:28

you'll see opacification of the temporal bones,

1:31

the mastoid air cells.

1:33

And that might be the clue that the patient

1:35

potentially has a temporal bone fracture.

1:39

So as I mentioned,

1:40

complications, when you have fractures that communicate

1:44

between the paranasal sinuses and

1:46

the intracranial compartment,

1:48

here we see fractures involving the frontal sinus and the upper

1:52

anterior ethmoid sinuses, these may lead to CSF leakage.

1:57

If you find any type of pneumocephalus

2:00

associated with a facial bone fracture,

2:04

be wary of the potential for communication between the

2:07

paranasal sinuses and the intracranial compartment

2:10

that can lead to meningitis,

2:12

meningoencephaloceles or even arterial/venous injury.

2:16

Here's an example of a fracture which was involving the

2:19

posterior wall of the frontal sinus and led to a large

2:23

collection of air in the anterior epidural space.

2:28

Here's one of the fractures that I always worry about,

2:30

and that is a fracture involving the lateral wall of the sphenoid.

2:34

When you see a fracture involving

2:36

the lateral wall of the sphenoid,

2:37

particularly at the cavernous portion

2:39

of the internal carotid artery,

2:40

you have to be concerned about the potential for injury

2:44

to that cavernous internal carotid artery.

2:46

In this case,

2:47

you see a little out pouching of the left

2:50

cavernous internal carotid artery.

2:52

The artery itself looks a little bit ballooned out.

2:55

This is a pseudo aneurysm of the left internal cavernous

3:00

portion of the internal carotid artery secondary to trauma,

3:03

associated with these sphenoid sinus

3:05

fractures. At the same time,

3:07

notice that this fracture looks like it's

3:09

involving potentially the optic canal.

3:13

Here's the lesser wing of the sphenoid.

3:15

So optic canal fractures may injure the optic nerve with

3:19

hematomas. So vascular injury as well as neuronal injury

3:23

on the same case where you have fractures

3:25

that cross the sphenoid sinus.

3:29

Here's the arteriogram

3:33

showing the coiling of that pseudoaneurysm that occurred

3:38

secondary to the fracture on the left

3:40

cavernous internal carotid artery.

3:42

Here's a different case of a patient who has a CC fistula,

3:47

secondary to trauma that crossed from the sphenoid sinus into the

3:52

cavernous sinus and affected a laceration of the internal

3:56

carotid artery that communicated with the cavernous sinus.

3:59

So a post-traumatic CC fistula.