Wk 2, Case 20 - Review

Report

History: Assault

Technique: Axial CT scan images were performed of the head and maxillofacial bones without administration of intravenous contrast. Multiplanar reformats were performed.

Findings:

Brain:

No acute hemorrhage or extra-axial collection. No midline shift, herniation, or hydrocephalus.

Gray-white differentiation is intact. Brain volume is age-appropriate.

Maxillofacial:

Bilateral comminuted fractures involving the alveolar ridge, lateral nasal bones, pterygoid plates, and inferior maxillary sinus walls (Le Fort I). Fractures extend to involve the hard palate with components through the central maxillary incisors. Large displaced fragment involving the alveolar process of the second and third molars measuring 2.5 x 1.4 cm within the oral cavity.

Comminuted and displaced fractures involving the right posterior alveolar ridge, right inferior orbital wall, and right medial orbital wall (Le Fort II). Mildly displaced fracture of the right lateral orbital wall involving the zygomaticofrontal suture (Le Fort III). Additional mildly displaced fractures of the right zygomatic arch.

Comminuted and displaced fracture involving the right mandibular angle with large medially displaced fragment measuring 2.1 cm. Hemorrhage within the right masticator space. Temporomandibular joints are normally positioned.

Herniation of fat contents though the inferior orbital wall defect without extraocular muscle entrapment. Scattered foci of gas within the right orbit. No postseptal hematoma.

Hemorrhage and debris layering within the frontal sinuses, ethmoid air cells, maxillary sinuses, and sphenoid sinuses. Mastoid air cells are clear.

Extensive soft tissue hematoma/swelling and soft tissue gas, primarily involving the right cheek, forehead, and nose. Additional soft tissue hematoma involving the left occipital scalp.

IMPRESSION:

Brain:

1. No acute intracranial abnormality.

Maxillofacial:

1. Bilateral Le Fort I fractures.

2. Right Le Fort II and III fractures.

3. Large fracture fragment involving the alveolar processes of the right second and third molars measuring 2.5 x 1.4 cm displaced within the oral cavity.

4. Comminuted and displaced fracture involving the right mandible.