Case 5 - Displaced Mandible Fracture At the Angle

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

15 year old presents with history of MVC. Status post motor vehicle collision with traumatic brain injury.

COMPARISON: None

TECHNIQUE: CT images of the head were obtained before contrast administration. CT images of the head and neck were obtained after the administration of IV contrast. 3-D MIP post processing imaging was performed.

FINDINGS:

Noncontast head CT:

Acute nondisplaced left squamosal temporal bone fracture extending vertically into the adjacent parietal bone. There is a thin acute subdural hematoma subjacent to the fracture measuring up to 4 mm in thickness.

Acute nondisplaced longitudinally oriented fracture of the right temporal bone which extends across the mastoid air cells, external ear canal and likely middle ear without obvious ossicular disruption. No definite involvement of the otic capsule. The
fracture extends anteromedially into the adjacent portions of the skull base, involving the right temporomandibular joint. No obvious involvement of the carotid canal or otic capsule, although it courses in the vicinity of the right petrous carotid
canal. There are tiny associated locules of intracranial gas along the tegmen mastoideum and the right temporal bone.

Left parietal scalp laceration/contusion. Right parietal scalp contusion. Small densities along the skin surface superficial to the right zygomatic arch and the right scalp with irregularity of the skin, likely representing laceration/foreign
bodies/debris. Left lateral periorbital subcutaneous contusion.

In addition, there is opacification of several left-sided mastoid air cells and a locule of extra mastoid gas within the left sigmoid fossa seen on image 9-60.

Thickening along the anterior tentorial leaflets.

No acute large territory infarct. No acute intracranial hemorrhage. No hydrocephalus. [No evidence of mass lesion or significant mass effect.]

Mild mucosal thickening in the ethmoid air cells and sphenoid sinuses.

Unremarkable orbits.

No acute fracture. No suspicious osseous lesion. No significant mastoid air cell or middle ear effusion.

Additional pertinent findings: None.


CTA Head:

Anterior circulation: No high grade stenosis, occlusion or aneurysm.

Posterior circulation: No high grade stenosis, occlusion or aneurysm. Right dominant vertebral artery.

The CTA head the is not optimized for assessment of the dural venous sinuses. There appears to be hypodensity in the anterior aspect of the sigmoid fossa as for instance seen on image 11-266. Given the arterial phase of imaging, this may represent
mixing
artifact from unopacified blood as the similar region on noncontrast imaging do not appear hyperdense suggestive of either thrombosis or hematoma. A locule of extra mastoid gas is again noted in this region.


CTA Neck:

Vessels: No high grade stenosis, occlusion or obvious vascular abnormality involving the major arteries of the neck.

Aerodigestive tract: Endotracheal tube in good position.
Cartilaginous structures of the neck: Normal.
Thyroid: Normal.
Parotid and submandibular glands: Normal.
Lymph nodes: No pathologically enlarged or suspicious lymph nodes.
Upper Chest: Consolidation in the upper portion of the left lower lobe. Faint groundglass opacities in the peripheral left upper lobe.
Bones: No acute osseous findings or suspicious osseous lesions.

Additional pertinent findings: Oral enteric tube present.





IMPRESSION:

1. Acute longitudinally oriented nondisplaced right temporal bone fracture, which appears to be otic sparing. It does involve the right temporomandibular joint and likely the right middle ear, without obvious ossicular disruption. Given proximity to
the
right carotid canal, difficult to exclude involvement; however, the internal carotid artery appears normal in caliber and contour.
2. Acute nondisplaced left temporoparietal bone fracture with subjacent 4 mm acute subdural hematoma.
3. Likely radiographically occult left mastoid fracture with a locule of adjacent extramastoid gas within the left sigmoid fossa. CTA was not optimized for assessment of the dural venous sinuses. There is lack of opacification within the anterior
aspect
of the left sigmoid sinus in this location which may very likely represent mixing artifact from the arterial phase of imaging. Consider obtaining dedicated dedicated technique CT of the temporal bones as well as CT venogram as some point for further
assessment of these findings.
4. Likely trace acute bilateral tentorial leaflet subdural hematomas.
5. Multiple scalp lacerations/contusions with multiple small likely foreign bodies and skin debris on the right.
6. No evidence of acute arterial injury in the head or neck.
7. Consolidation in the left lower lobe and peripheral left upper lobe pulmonary opacities may represent contusion and/or aspiration.