Interactive Transcript
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This was a young child who fell out of a stroller
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and landed and hit the facial structures.
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And this case will demonstrate some of the
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more unusual types of orbital fractures.
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So I'm just going to focus on the axial CT scans
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and point out a few findings.
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So obviously,
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first thing we will see is the air fluid level in the
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right maxillary antrum and the left maxillary antrum.
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We see that the patient has nasal bone fractures,
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which we'll discuss in a moment.
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But let's focus on the orbit.
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So as we come up further superiorly on the right side,
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focusing there,
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we see some air at the foramen rotundum.
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We see some air coursing to the superior orbital fissure,
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and we see some air cutting across the
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anterior clinoid process.
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This is a fracture which is crossing the orbital apex.
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Here is the optic nerve canal, the optic canal.
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And the fracture goes just above the optic canal
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with small areas of air seen in that location.
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You notice that it communicates across to the
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medial orbital wall at its posterior most portion.
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This is a very unusual location for
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a fracture at the orbital apex.
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But it points out what the risk factor is, that this
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can then, at this narrowest portion of the orbit,
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lead to a compression of the optic nerve
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when you have a hematoma there.
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Although we will talk a little bit
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more about this case later on
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when we're talking about the other types of fractures.
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I do want to point out that this patient also has
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a fracture which goes across the top of the
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orbit. So orbital roof fractures.
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These are usually when there is a big pressure in the
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orbital space that drives the fracture generally
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superiorly into the intracranial compartment.
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So we have to be very careful here about our coronal images.
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I want to point out that these are the thin section,
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0.75 millimeter thick sections. I've shown you
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previously coronal and sagittal reconstructions.
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You notice that the coronal and sagittal reconstructions
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are two millimeter or three millimeter
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in some of the examples I gave you.
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It is not uncommon for me to make my own coronal and
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sagittal reconstructions from the 0.75 mm.
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So that way I have even thinner section than what is
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provided to me by the technologists or
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the scanner that are two to 3 mm.
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So if you need that higher resolution,
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take those thin sections at 0.75 and
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reconstructive and coronal, and sagittal also in thin section.
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Here we can see a large laceration with a foreign body
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over the forehead. Let's look at the coronal reconstruction.
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So in this example, you can see the orbital roof fracture,
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which is shearing off a portion of the anterior clinoid
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process, and we are... here is the optic canal.
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So in point of fact,
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the fracture doesn't actually cross the optic canal.
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It's just in close proximity to it.
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But we do see the fracture involving the roof
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of the orbit. Note the small amount of air.
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I'll magnify that for you.
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So here's the small amount of air.
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Again, whenever I see that,
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I'm going to be very suspicious of an adjacent
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fracture. And here that fracture is.
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And the next thing we want to do is
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to look at the soft tissue windows.
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Why do we want to look at the soft tissue windows?
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We want to look of the orbital apex to see whether this optic
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nerve is being compressed at all by adjacent
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hemorrhage associated with the fracture.
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And this is about as good as you're going to see symmetry
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from side to side in the orbital apex.
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So, in point of fact,
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there isn't a large hematoma associated with this fracture
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that was involved in the interclinoid and the
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soft tissues just adjacent to the optic canal.
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