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Prepare trainees to be on call for the emergency department with this specialized training series.
Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 1 min.
19 topics, 1 hr. 35 min.
Clinical Scenario 1: Orbital Trauma/Inflammation Introduction
2 m.Case: Anterior Segment Ocular Injury
9 m.Ocular Injury & Globe Anatomy
6 m.Case: Choroidal Detachment, Retinal Detachment, Vitreous Hemorrhage, Orbital Floor Fracture
9 m.Orbit: Foreign Body
8 m.Orbit: Non-Accidental Trauma with Retinal Hemorrhage
3 m.Early Ocular Intervention
6 m.Non-Ocular Orbital Trauma
3 m.Case: Orbital Wall Fracture
8 m.Case: Medial Orbital Wall Fracture
8 m.Case: Orbital Apex and Roof Fracture
5 m.Orbital Blow-Out Fractures
6 m.Orbital Trauma
5 m.Indications for Surgery
4 m.Case: Orbital Cellulitis with Subperiosteal Abscess
6 m.Orbital Inflammation
5 m.Pediatric Subperiosteal Abscess
4 m.Orbital Pseudotumor and Carotid Cavernous Fistula
7 m.Orbital Trauma/Inflammation Lesson Reinforcement Quiz
29 topics, 1 hr. 34 min.
Clinical Scenario 2: Facial/Neck Trauma Introduction
6 m.Case: Comminuted Nasal Bone Fracture
2 m.Case: Multiple Fractures in Nasal Bones
3 m.Nasal Bone Fracture Summary
3 m.Mandibular Fractures
6 m.Case: Displaced Mandibular Fracture at the Angle
3 m.Midface Buttresses
3 m.Naso-Orbito-Ethmoid (NOE) Fractures
5 m.Case: NOE Fracture
3 m.Case: Midface NOE Fracture
3 m.Le Fort Fractures
7 m.Case: Bilateral Le Fort 1 & 2 Fractures
4 m.Case: Bilateral Le Fort 1, Unilateral Le Fort 2 & 3
4 m.Le Fort Summary
1 m.Zygomaticomaxillary Complex (ZMC) Fractures
5 m.Case: Zygomaticomaxillary Complex Fracture
3 m.ZMC Summary
2 m.Capo de Tutti Fractures
5 m.Case: Bilateral Temporal Bone Fractures
9 m.Temporal Bone Fractures
2 m.Complications of Temporal Bone Injury
3 m.Temporal Bone Fracture Summary
3 m.Case: Calvarial Fracture with Transverse Sinus Injury
3 m.Case: Carotid Dissection with Pseudoaneurysm
5 m.Case: Bilateral Carotid Dissections
4 m.Case: Horner's Syndrome, MS, Dissection
5 m.Case: Horner's Syndrome
5 m.Airway Injury & Carotid Dissection
4 m.Facial/Neck Trauma Lesson Reinforcement Quiz
12 topics, 46 min.
Clinical Scenario 3: Sore Throat Pain and Fever Introduction
1 m.Tonsillitis, Tonsillar Abscess & Peritonsillar Abscess
6 m.Case: Peritonsillar Abscess
5 m.Case: Peritonsillar Phlegmon
6 m.Case: Epiglottitis, Supraglottitis, Airway Compromise
7 m.Periodontal Disease
9 m.Case: Ludwig's Angina
3 m.Ludwig's Angina - Summary
3 m.Case: Ludwig's Angina, Sialadenitis
4 m.Lemierre's Syndrome
2 m.Malignant Otitis Externa & Otomastoiditis
6 m.Sore Throat Pain and Fever Lesson Reinforcement Quiz
12 topics, 42 min.
Clinical Scenario 4: Mass in the Neck Introduction
4 m.Case: T-Cell Lymphoma, Lymphadenopathy
4 m.Retropharyngeal Space
3 m.Case: Retropharyngeal Abscess
4 m.Case: Retropharyngeal Phlegmon
3 m.Retropharyngeal Space Collections
4 m.Neck Mass in Afebrile Patient
7 m.Case: Second Branchial Cleft Cyst
4 m.Case: Thyroglossal Duct Cyst
5 m.Case: Sarcoma of the Levator Scapulae
2 m.Thyroid Nodules
9 m.Mass in the Neck Lesson Reinforcement Quiz
26 topics, 1 hr. 35 min.
Clinical Scenario 5: Cervical Spine Trauma Introduction
7 m.Case: Occipital Condyle Fracture
2 m.Case: Anterior Arch C1 Fracture
6 m.Case: Odontoid Fracture
4 m.Atlanto-Odontoid Distraction
5 m.Odontoid Fractures: Summary
5 m.Atlanto-Odontoid Versus Atlanto-Axial Distractions
4 m.Case: Jefferson Fracture on CT, MRI
7 m.Jefferson (Burst) Fracture: Summary
4 m.Fixed Rotatory Subluxation
4 m.Case: Bilateral Jumped Facets
9 m.Unilateral Facet Dislocation with Carotid Dissection
4 m.Hyperextension Injury
4 m.Cervical Spine Flexion Injury
6 m.Case: Transverse Process Fracture
3 m.Case: Unstable Fracture, Two-Column Injury
6 m.Case: Facet Fracture with Vertebral Artery Occlusion
4 m.Spinal Cord Injury Without Radiographic Abnormalities
4 m.Thoracolumbar AO Spine Injury Score
2 m.Case: Chance Fracture
2 m.Axial Loading Fractures
5 m.Case: Lumbar Transverse Process Fracture
2 m.Lumbar Transverse Process Fractures and Visceral Injury
3 m.Case: Compression Fracture
4 m.Case: Compression Fracture & Stress Injury
3 m.Cervical Spine Trauma Lesson Reinforcement Quiz
9 topics, 28 min.
Clinical Scenario 6: Fever, Back Pain Introduction
2 m.Case: Diskitis-Osteomyelitis
5 m.Diskitis-Osteomyelitis Summary
6 m.Case: Tuberculous Spondylitis with Psoas Abscess
4 m.Case: Spinal Cord Infarct
5 m.Case: Spinal Cord Astrocytoma
2 m.Case: Guillain-Barré Syndrome
2 m.Grisel Syndrome and Calcific Tendinitis of the Longus Colli
6 m.Fever, Back Pain Lesson Reinforcement Quiz
13 topics, 37 min.
Head and Neck Emergencies Introduction
8 m.Case: Fungus Ball
2 m.Fungal Sinusitis Summary
2 m.Allergic Fungal Rhinosinusitis
7 m.Case: Invasive Fungal Sinusitis
4 m.Invasive Fungal Sinusitis Imaging Signs
4 m.Case: Necrotizing Fasciitis
4 m.Necrotizing Fasciitis Summary
2 m.Case: Allergic Fungal Sinusitis with Mucocele
2 m.Epidural Abscess from Sinusitis
3 m.Case: Otomastoiditis with Bezold Abscess
2 m.Case: Sinusitis with Frontal Lobe Abscess
3 m.Head and Neck Emergencies Lesson Reinforcement Quiz
0:01
As I mentioned earlier,
0:02
it's not unusual to see asymmetric Le Fort fractures.
0:07
Let's look at this individual's fracture pattern.
0:11
So if we look at the anterior maxilla,
0:15
we can see the comminuted fracture on the right side.
0:19
The left side also has a fracture,
0:22
and that's comminuted on the left, as well.
0:25
And this fracture fragment kind of crosses the midline.
0:29
So off the bat on the axials,
0:32
we're going to see that this patient has a Le Fort I
0:34
fracture. When we look at the orbital floor,
0:37
we can see that the orbital floor on the right
0:40
side has a comminuted fracture,
0:42
but the left side doesn't look all that bad.
0:45
Finally, when we look at the medial orbital wall,
0:47
we can see the irregularity of the medial orbital
0:49
wall on the right, but not on the left.
0:52
When we look at the lateral orbital wall on the left side,
0:55
this is intact with that normal suture.
0:58
However,
0:58
here we can see a comminuted fracture on the left side.
1:03
Let's look at the pterygoid plates.
1:06
Bilateral comminuted pterygoid plate fracture.
1:11
So we are in the category likely of a Le Fort fracture.
1:16
So we move to the coronal scan.
1:17
As I mentioned, the coronal scan,
1:19
because it shows those planes of the transverse buttresses,
1:23
is actually a better orientation to evaluate Le Fort fractures.
1:29
So here we have a fracture which goes across the
1:33
maxilla from one side to the other and out.
1:37
So fulfilling our criteria,
1:40
which you can see right across here,
1:42
fulfilling our criteria of a Le Fort I fracture.
1:46
If we look on the left side, this orbital floor,
1:51
although it seems as if we're missing an area of bone,
1:54
actually, on the thin section images,
1:57
you do not see a fracture in this location.
2:00
So the orbital floor on the left side was intact.
2:03
No edema in the fat nearby.
2:06
However, on the contralateral side,
2:08
you can see that there's orbital fat herniating through
2:12
this comminuted fracture of the right orbital floor.
2:16
So we have a fracture going through the maxilla
2:19
and going through the orbital floor.
2:21
And then we look at the medial orbital wall,
2:24
and that was shown here with the defect
2:27
that was also evident on the axial scans involving the medial
2:33
orbital wall. So we have a Le Fort II on the right side,
2:39
but just a Le Fort I on the left side.
2:42
But we're not done yet.
2:43
We mentioned the lateral orbital wall.
2:46
Here you can see the air and the widening
2:51
of the suture along the lateral orbital wall.
2:55
It's actually going into the zygoma and
2:57
the zygomatic of frontal suture, but
3:00
this lateral orbital wall is not intact.
3:03
And so if we have a lateral orbital wall and a medial
3:08
orbital wall fracture, then we have a Le Fort III.
3:12
So here's our medial orbital wall fracture.
3:14
Here's our lateral orbital wall.
3:16
Le Fort III fracture. So bilateral, Le Fort I.
3:22
Unilateral, La Fort II. Unilateral, Le Fort III.
Interactive Transcript
0:01
As I mentioned earlier,
0:02
it's not unusual to see asymmetric Le Fort fractures.
0:07
Let's look at this individual's fracture pattern.
0:11
So if we look at the anterior maxilla,
0:15
we can see the comminuted fracture on the right side.
0:19
The left side also has a fracture,
0:22
and that's comminuted on the left, as well.
0:25
And this fracture fragment kind of crosses the midline.
0:29
So off the bat on the axials,
0:32
we're going to see that this patient has a Le Fort I
0:34
fracture. When we look at the orbital floor,
0:37
we can see that the orbital floor on the right
0:40
side has a comminuted fracture,
0:42
but the left side doesn't look all that bad.
0:45
Finally, when we look at the medial orbital wall,
0:47
we can see the irregularity of the medial orbital
0:49
wall on the right, but not on the left.
0:52
When we look at the lateral orbital wall on the left side,
0:55
this is intact with that normal suture.
0:58
However,
0:58
here we can see a comminuted fracture on the left side.
1:03
Let's look at the pterygoid plates.
1:06
Bilateral comminuted pterygoid plate fracture.
1:11
So we are in the category likely of a Le Fort fracture.
1:16
So we move to the coronal scan.
1:17
As I mentioned, the coronal scan,
1:19
because it shows those planes of the transverse buttresses,
1:23
is actually a better orientation to evaluate Le Fort fractures.
1:29
So here we have a fracture which goes across the
1:33
maxilla from one side to the other and out.
1:37
So fulfilling our criteria,
1:40
which you can see right across here,
1:42
fulfilling our criteria of a Le Fort I fracture.
1:46
If we look on the left side, this orbital floor,
1:51
although it seems as if we're missing an area of bone,
1:54
actually, on the thin section images,
1:57
you do not see a fracture in this location.
2:00
So the orbital floor on the left side was intact.
2:03
No edema in the fat nearby.
2:06
However, on the contralateral side,
2:08
you can see that there's orbital fat herniating through
2:12
this comminuted fracture of the right orbital floor.
2:16
So we have a fracture going through the maxilla
2:19
and going through the orbital floor.
2:21
And then we look at the medial orbital wall,
2:24
and that was shown here with the defect
2:27
that was also evident on the axial scans involving the medial
2:33
orbital wall. So we have a Le Fort II on the right side,
2:39
but just a Le Fort I on the left side.
2:42
But we're not done yet.
2:43
We mentioned the lateral orbital wall.
2:46
Here you can see the air and the widening
2:51
of the suture along the lateral orbital wall.
2:55
It's actually going into the zygoma and
2:57
the zygomatic of frontal suture, but
3:00
this lateral orbital wall is not intact.
3:03
And so if we have a lateral orbital wall and a medial
3:08
orbital wall fracture, then we have a Le Fort III.
3:12
So here's our medial orbital wall fracture.
3:14
Here's our lateral orbital wall.
3:16
Le Fort III fracture. So bilateral, Le Fort I.
3:22
Unilateral, La Fort II. Unilateral, Le Fort III.
Report
Faculty
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
Tags
Trauma
Neuroradiology
Maxillofacial
Head and Neck
Emergency
CT
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