Craniofacial trauma Flashcards

1
Q

superior in the detection of acute epidural and subdural hematomas and non-hemorrhagic brain injury

A

MRI

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2
Q

more sensitive modality in brainstem injury and to subacute to chronic hemorrhage

A

MRI, especially with FLAIR, GRE and SWI

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3
Q

particularly sensitive in detection of blood products and can identify small areas of hemorrhage undetectable on GRE sequences or even CT

A

SWI

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4
Q

provides improved detection of both acute and chronic neuronal injury

A

DWI and DTI

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5
Q

most common manifestation of scalp injury and can be recognized on CT or MR as focal soft tissue swelling of scalp, located beneath the subcutaneous fibrofatty tissue and above the temporalis muscle and calvarium

A

subgaleal hematoma

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6
Q

isolated linear skull fractures are managed

A

do not require tx

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7
Q

management of depressed and compound skull fractures

A

surgical management

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8
Q

fractures of the temporal bone can be classified either according to the following

A

orientation relative to the long axis of petrous bone or according to their involvement of the otic capsule

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9
Q

if a temporal bone fracture parallels the long axis of the petrous pyramid, it is termed

A

“longitudinal” fracture

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10
Q

temporal fractures perpendicular to the long axis of the petrous bone are termed

A

transverse fractures

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11
Q

represents 70 to 90% of temporal bone fractures. it results from blow to the side of the head

A

longitudinal temporal bone fx

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12
Q

complications in longitudinal temporal bone fx

A

conductive hearing loss, dislocation or fx of the ossicels and CSF otorhinorrhea, delayed or incomplete facial nerve palsy

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13
Q

results from a blow to the occiput or frontal region

A

transverse temporal bone fracture

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14
Q

complications of transverse temporal bone fx

A

sensorineural hearing loss, severe vertigo, nystagmus and perilymphatic fistula, facial palsy in 30 to 50%, injury to carotid artery or jugular vein

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15
Q

fx that run anterolateral to the otic capsule and are usually caused by direct blows to the temporoparietal region

A

otic capsule- sparing fractures

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16
Q

fx wherein the cochlea and semicircular canals are damaged. these fx are the result of direct impacts to the occipital region

A

otic capsule- violating fx

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17
Q

complications of otic capsule-violating fx

A

facial nerve injury, CSF leak, hearing loss, intracranial injuries such as epidural hematoma and SAH

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18
Q

vessel origin of epidural hematomas

A

arterial, middle meningeal artery

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19
Q

skull fractures are seen in 85 - 95% of what extra-axial hemorrhage

A

epidural hge

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20
Q

common location of epidural hematomas

A

temporal or temporoparietal location

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21
Q

venous epidural hematomas are less common, tends to occur at what areas

A

vertex, posterior fossa, or anterior aspect of the middle cranial fossa

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22
Q

what collection can cross the falx cerebri

A

epidural

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23
Q

shape of epidural collection

A

lenticular or biconvex

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24
Q

extra-axial collection that does not cross cranial sutures, where the periosteal layer of the dura is firmly attached. Near the vertex however, the periosteum forms the outer wall of the sagittal sinus and is less tightly adherent to the sagittal suture. therefore, in this region, this extra-axial collection can cross midline

A

epidural

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25
Q

subdural hemorrhages are typically what vessel of origin

A

venous, cortical veins, may also result form disruption of penetrating branches of superficial cerebral arteries

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26
Q

subdural hematoma typically extends over a much larger area that epidural hematoma because

A

the inner dural layer and arachnoid are not as firmly attached as the structures that make up the epidural space

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27
Q

subdural hematomas commonly present after what type of injury

A

acute deceleration injury from MVA or fall

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28
Q

brain injury freq seen with acute subdural hematomas

A

cortical contusions and DAI

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29
Q

shape of subdural collection

A

crescent shaped

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30
Q

common location of subdural hematomas

A

supratentorial, located along the convexity. freq seen along the falx and tentorium

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31
Q

subdural collections will not cross the falx cerebri and tentorium due to

A

dural reflections form falx cerebri and tentorium

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32
Q

subdural hematomas can cross sutures or not

A

can cross sutures

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33
Q

acute hemorrhage may appear isodense or hypodense on ct, in patients with what comorbidities

A

severe anemia or active extravasation (hyperacute subdural hematoma)

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34
Q

sediment level in extra-axial hematoma called _____ may be seen either from rebleeding or in patients with clotting disorders

A

hematocrit effect

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35
Q

contrast study may help distinguish chronic subdural hematoma from atrophy by the demonstration of

A

an enhancing capsule or displaced cortical veins

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36
Q

transition from acute to chronic subdural hematomas called isodense phase occurs usually between how many days to weeks after the acute event

A

several days and 3 weeks

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37
Q

indirect signs of subdural hemorrhage in isodense phase

A

effacement of sulci, effacement or distortion of the white matter (“white matter buckling”), abnormal separation of the gray-white matter junction from the inner table of the skull (“thick gray matter mantle”), distortion fo ventricles and midline shift

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38
Q

dependent layering of the acute, denser blood products within the chronic, hypodense collections is often referred to as the

A

“hematocrit sign”

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39
Q

acute subdural hematomas appearance on MRI

A

isointense to brain on T1, hypointense on T2

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40
Q

subacute subdural hematoma appearance on MRI

A

high signal on T1, due to presence of methemoglobin

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41
Q

as hemorrhage ages in chronic subdural hematomas, they appear what on MRI

A

T2 signal increases and T1 signal gradually decreases as the hge ages

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42
Q

shape of subacute subdural hematomas frequently have a ____ appearance when seen in the coronal plane

A

lentiform or biconvex appearance, rather than the crescent-shaped appearance that is characteristic on axial CT scans

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43
Q

extra-axial hemorrhage that is common in head injury but is rarely large enough to cause a significant mass effect. it results from the disruption of small subarachnoid vessels or direct extension into the subarachnoid space by a contusion or hematoma

A

subarachnoid hemorrhage

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44
Q

sensitive MR sequence in detecting hyperacute SAH

A

FLAIR and SWI

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45
Q

mechanisms of intraventricular hemorrhage

A

can result from rotationally induced tearing of subependymal veins on the surface of the ventricles, direct extension of a parenchymal hematoma into the ventricular system, intraventricula blood can result from retrograde flow of SAH into the ventricular system thru the fourth ventricular outflow foramina

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46
Q

patients with IVH are at risk for

A

subsequent hydrocephalus by obstruction either at the level of aqueduct or arachnoid villi

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47
Q

MC type of primary neuronal injuries in patients with severe head trauma

A

DAI

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48
Q

characterized by widespread disruption of axons that occurs at the time of an acceleration or deceleration injury. direct impact is not necessary to cause this type of injury

A

DAI

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49
Q

patients with this type of brain injury are most commonly due to high-speed motor vehicle crashes. these lesions have not been seen as a consequence of simple falls

A

DAI

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50
Q

loss of consciousness is typically seen in what brain injury that immediately occurs after this injury

A

DAI

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51
Q

DAI presents as

A

small petechial hges at the gray-white junction of the cerebral hemispheres or corpus callosum

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52
Q

On MR, nonhemorrhagic DAI lesions appear as

A

small foci of T2 prolongation (increased signal) on FLAIR images or low ADC on DWI within the white matter

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53
Q

hemorrhagic DAI appears as

A

low signal on GRE or SWI

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54
Q

characteristic locations of DAI in terms of severity

A

Mild- frontal and temporal white matter, near the gray-white junction, parasagittal regions of frontal lobes and periventricular regions of temporal lobes
More severe- lobar white matter as well as corpus callosum, esp posterior body and splenium
Most severe- dorsolateral aspect of midbrain and upper pons , in addition to lobar white matter and corpus callosum

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55
Q

part of brain that is affected by DAI in 20% of cases

A

corpus callosum

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56
Q

manner of injury in DAI of corpus callosum

A

rotational shear forces

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57
Q

corpus callosum is particularly susceptible to DAI because

A

the falx prevents displacement of the cerebral hemispheres

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58
Q

areas of focal brain injury primarily involving the superficial gray matter. this lesions are much less likely to have loss of consciousness at the time of injury than are the patients with DAI

A

cortical contusions

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59
Q

common sites for cortical contusions

A

temporal lobes above the petrous bone or posterior to the greater wing of sphenoid, frontal lobes above the cribriform plate, planum sphenoidale, lesser sphenoid wing, less than 10% involve the cerebellum, margins of depressed skull fractures

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60
Q

cause of markedly decreased signal on GRE or SWI as a sign of prior hemorrhage

A

hemosiderin deposit

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61
Q

these hematomas tend to have less surrounding edema than cortical contusions because they represent bleeding into areas of relatively normal brain. they are not necessarily associated with cortical contusion but rather represents shear-induced hemorrhage from rupture of small intraparenchymal blood vessels

A

intracerebral hematoma

62
Q

most intracerebral hematomas are located in the

A

frontotemporal white matter

63
Q

active extravasation of contrast into the hematoma is called ___. it predicts future expansion of hematoma and worsens clinical outcime

A

spot sign

64
Q

uncommon manifestation of primary intra-axial injury and is seen as multiple, petechial hemorrhages primarily affecting the basal ganglia and thalamus. these represent microscopic perivascular collections of blood that may result from disruption of multiple small perforating vessels

A

subcortical gray matter injury

65
Q

arterial injury commonly accompanies fractures of the

A

base of the skull

66
Q

most frequently injured artery, especially at sites of fixation

A

ICA, entrance to carotid canal at base of petrous bone and at its exit from the cavernous sinus below the anterior clinoid process

67
Q

MR findings of vascular injury include

A

presence of an intramural hematoma (best seen on T1 with fat sat), or intimal flap with dissection, absence of normal vascular flow void with occlusion

68
Q

imaging that are often needed to confirm and delineate dissections and may also show spasm or pseudoaneurysm formation in injuries to the vessel wall

A

conventional angiograms

69
Q

communication between the cavernous portion of ICA and surrounding venous plexus. the lesion typically follows a full-thickness arterial injury, resulting in venous engorgement of cavernous sinus and its draining tributaries

A

carotid cavernous fistula

70
Q

on CTA or MR, this lesion may manifest as enlarged superior ophthalmic vein, cavernous sinus, and petrosal sinus flow voids

A

carotid cavernous fistula

71
Q

may be caused by laceration of middle meningeal artery with resultant meningeal artery to meningeal vein fistula formation

A

dural fistulas

72
Q

cortical contusions and intracranial hemorrhages are more severe when

A

the period of acceleration or deceleration is very short, such as falls

73
Q

DAI and gliding contusions are associated with what type of injuries

A

longer acceleration or deceleration injury, such as in MVA

74
Q

refers to an increase in blood volume

A

hyperemia

75
Q

refers to an increase in tissue fluid

A

edema

76
Q

cerebral swelling from hyperemia is most commonly seen in what age group due to loss of normal cerebral autoregulation

A

children and adolescents

77
Q

diffuse cerebral edema occurs secondary to

A

tissue hypoxia

78
Q

herniation in which the cingulate gyrus is displaced across the midline under the falx cerebri. it is the most common of brain herniation

A

subfalcine herniation

79
Q

enlargement of the contralateral ventricle in subfalcine herniation is secondary to obstruction of what foramen

A

foramen of Monro

80
Q

this herniation are at risk for ACA infarction in the distribution of callosomarginal branch of ACA, where it becomes trapped against the falx

A

subfalcine herniation

81
Q

type of herniation in which the medial aspect of the temporal lobe is displaced medially over the free margin of tentorium. causes effacement of ambient cistern and the lateral aspect of suprasellar cistern

A

uncal herniation

82
Q

focal impression on the cerebral peduncle is known as

A

“Kernohan notch”

83
Q

type of herniation at risk for mass effect on 3rd cranial nerve and compression of contralateral cerebral peduncle causing a recognizable clinical syndrome characterized by a blown pupil with ipsilateral hemiparesis

A

Uncal herniation

84
Q

type of herniation that can be either downward or upward across the tentorium

A

transtentorial herniation

85
Q

recognized by effacement of the suprasellar and perimesencephalic cisterns

A

descending transtentorial herniation

86
Q

type of herniation in which the pineal calcifications which are about the same level as calcified choroid plexus in the trigones of lateral ventricles, is displaced inferiorly

A

descending transtentorial herniation

87
Q

type of herniation in which the vermis and portions of cerebellar hemispheres can herniate through the tentorial incisura

A

ascending transtentorial herniation

88
Q

type of herniation that can occur in which swelling or mass effects causes the brain to herniate thru a calvarial defect

A

external herniation

89
Q

can occur after subarachnoid or intraventricular hemorrhage as a result of either impaired CSF reabsorption at the level of the arachnoid granulations or obstruction at the level of aqueduct or fourth ventricular outflow foramina

A

hydrocephalus

90
Q

posttraumatic ischemia or infarction can result from

A

raised ICP, embolization from a vascular dissection or direct mass effect on cerebral vasculature from brain herniation or an overlying extra-axial collection

91
Q

ischemia or infarction secondary to globally reduced cerebral perfusion tends to occur in characteristic ____ zones and is not specific for trauma

A

“watershed zones”

92
Q

CSF leak requires a ___ and can occur after calvarial or skull base fractures

A

dural tear

93
Q

occurs subsequent to fractures in which communication develops between the subarachnoid space and the paranasal sinuses or middle ear cavity

A

CSF rhinorrrhea

94
Q

occurs when communication between the subarachnoid space and middle ear occurs in association with disruption of tympanic membrane

A

CSF otorrhea

95
Q

highly sensitive for presence of CSF extravasation

A

radionuclide cisternography

96
Q

aka “growing fracture” is caused by a traumatic tear in the dura, which allows an outpouching of arachnoid to occur at the site of a suture or skull fracture. this leads to progressive, slow widening of the skull defect or suture, presumably as a result of CSF pulsation

A

leptomeningeal cyst

97
Q

consists of tissue loss with surrounding gliosis and is a frequent manifestation of remote head injury. it may be asymptomatic or serve as a potential seizure focus

A

encephalomalacia

98
Q

gliosis appears what on both FLAIR and T2

A

high SI

99
Q

appearance of encephalomalacia is not specific for posttraumatic injury, but the locations are characteristic:

A

anteroinferior frontal and temporal lobes

100
Q

focal volume loss along the white matter tracts associated with cell death is known as

A

Wallerian degeneration

101
Q

most common form of primary brainstem injury is, which affecs the dorsolateral aspect of midbrain and upper pons

A

DAI

102
Q

particularly vulnerable areas in primary brainstem injury

A

superior cerebellar peduncles and medial lemnisci

103
Q

extreme rare form of indirect primary brainstem injury is the ___. this represents a tear in the ventral surface of the brainstem at the junction of the pons and medulla

A

pontomedullary separation or rent

104
Q

secondary brainstem lesions that occur as a result of downward herniation or hypoxia or ischemia, usually involve what part of brainstem

A

ventral or ventrolateral aspect of the brainstem

105
Q

this is a midline hematoma in the tegmentum of the rostral pons and midbrain seen in association with descending transtentorial herniation. it is believed to result from stretching or tearing of penetrating arteries as the brainstem is caudally displaced

A

Duret hemorrhage

106
Q

another type of secondary brainstem injury that typically occurs in the central tegmentum of the pons and midbrain

A

brainstem infarct

107
Q

Mild head injury GCS score

A

13 to 15

108
Q

Moderate head injury GCS score

A

9 to 12

109
Q

Severe head injury GCS score

A

8 and below

110
Q

accounts for at least 80% of deaths from head trauma in children younger than 2 years of age

A

nonaccidental trauma

111
Q

represent the second most common skeletal injury in child abuse after long bone fracture

A

skull fractures

112
Q

most commonly recognized intracranial complications from child abuse

A

subdural hemorrhages

113
Q

described as “whiplash shaken injury” by Caffey

A

subdural hematomas, retinal hemorrhages in children with metaphyseal long bone fractures

114
Q

subdural hematomas in child abuse often are found in the

A

posterior interhemispheric fissure

115
Q

this can mimic chronic subdural hematomas in neurologically intact infants 3 to 6 months old who present with enlarging head circumference. usually regress by age of 2

A

benign enlargement of the subarachnoid space of infancy

116
Q

true or false: epidural hematomas are not frequently seen in child abuse

A

true

117
Q

most common intra-axial manifestation of head injury related to child abuse is

A

diffuse brain swelling

118
Q

four plain film views for evaluation of facial trauma

A

caldwell view, shallow waters view, crosstable lateral view and submental vertex view

119
Q

orbital emphysema is most commonly caused by fracture of the

A

thin medial orbital wall

120
Q

most common fractures of the facial skeleton

A

nasal bone fractures

121
Q

nasal fractures that can be confused with the nasomaxillary suture and nasociliary grooves, which have the same orientation

A

longitudinal fx

122
Q

nasal bone fractures that are more common and are easily detected because they are are oriented perpendicular to the normal suture line

A

transverse fracture

123
Q

trauma to this nasal area may lead to hematoma formation between the perichondrium and cartilage, which can cause cartilage necrosis by disrupting the vascular supply

A

septal cartilage

124
Q

most common isolated maxillary fx. frequently results from blow to the chin that drives the teeth of the mandible into the maxillary dental arch

A

fracture of the maxillary alveolus

125
Q

most common isolated sinus fracture involves the

A

anterolateral wall of maxillary antrum

126
Q

isolated orbital wall fractures involve what walls

A

medial wall or orbital floor

127
Q

what type or orbital fracture is rarely associated with entrapment

A

orbital floor fx

128
Q

fragments from an orbital floor fracture buckle upward into the orbit, an injury referred to as a

A

“blow-in” fracture

129
Q

appear as biconve high-density collections along the posterior aspect of the globe, bounded by the optic nerve

A

subretinal hemorrhage

130
Q

may occur as a result of decelertion strain, causing damage to the delicate meningeal vessels or direct neural disruption of optic nerve

A

primary optic nerve injury

131
Q

type of optic nerve injury that may occur as a result of swelling of the optic nerve within the rigid bony canal with subsequent mechanical compression and vascular compromise

A

secondary optic nerve injury

132
Q

one of the most common sites of injury in fractures that involbe multiple facial bones

A

fractures of the zygoma

133
Q

on plain films, zygomatic arch is best evaluated on what view

A

submental vertex view

134
Q

zygoma articulates with

A

frontal, maxillary, sphenoid and temporal bones

135
Q

zygomaticomaxillary complex fractures typically involves the

A

zygomatic arch, zygomaticofrontal suture, infraorbital rim, orbital floor, lateral wall of maxillary sinus, lateral wall of orbit

136
Q

injury to this nerve is common in zygomaticomaxillary complex fractures, secondary to fracture of the infraorbital rim at the infarorbital foramen

A

infraorbital nerve injury

137
Q

all Le Fort fractures involve the ____, which helps anchor the facial bones to the skull

A

pterygoid plates

138
Q

type of Le Fort: “floating palate”, horizontal fracture through the maxillary sinuses. etends thru the nasal septum and walls of the maxillary sinuses into the inferior aspect of the pterygoid plates. recognized by fracture of all walls of both maxillary sinuses

A

Le Fort I

139
Q

type of Le Fort: “pyramidal” fracture. fracture thru the medial orbital and lateral maxillary walls. begins at the bridge of the nose and extends in a pyramidal fashion thru the nasal septum, frontal process of maxilla, medial wall of orbit, inferior orbital rim, superior, lateral and posterior walls of the maxillary antrum, midportion of pterygoid plates. zygomatic arch and lateral orbital walls are left intact. usually associated with postrior displacement of the facial bones, resulting in a “dish-face” deformity and malocclusion. infraorbital nerve is freq injured

A

Le Fort II

140
Q

type of Le Fort: “craniofacial disjunction”, is a horizontally oriented fx thru the orbits. It begins near the nasofrontal suture and extends posteriorly to involve the nasal seputm, medial and lateral orbital walls, zygomatic arch, base of pterygoid plates. also have dish-face deformtiy and malocclusion. infraorbital nerve injury is less common. elongated appearnce of the orbits on Waters and Caldwell views

A

Le Fort III

141
Q

describes the constellation of findings seen as a result of a blow to the midface between the eyes. this may include fx of lamina papyracea, inferior, medial and supraorbital rims, frontal or ethmoid sinuses, orbital roofs, nasal bone and frontal process of maxilla, sphenoid bone

A

nasoethmoidal complex injuries/orbitoethmoid or nasoethmoid-orbital fractures

142
Q

on plain films, this fracture shows posterior displacement of the nasion in lateral view

A

nasoethmoidal fractures

143
Q

nerve that is frequently injured when nasoethmoidal complex fractures injure this structure

A

cribriform plate

144
Q

mandibular series includes

A

PA lateral, Towne and bilateral oblique projections

145
Q

simple mandibular fx are most common in the ______ and do not communicate externally or with the mouth

A

ramus and condyle

146
Q

compound mandibular fractures are those that communicate internally thru

A

a tooth socket or externally through a laceration

147
Q

fractures of the body of the mandible are almost always a

A

compound fx

148
Q

subcondylar mandibular fx are often recognized on plain films by _____ sign, a well corticated density seen abive the condylar neck on lateral views because of the horizontal axis of the fragment

A

cortical ring sign

149
Q

common pattern of mandibular injury

A

unilateal condylar fx with contralateral fx of the mandibular angle

150
Q

most common site of isolated mandibular injury

A

mandibular angle