Facial Bones Pathology

Question 1

What is a key sign of pathology/# to look out for?

Answer 1

fluid levels and soft tissue masses in the sinuses

Question 2

What are the direct radiographic signs? - 5 points

Answer 2

linear lucencies
corticol break
widened suture
bone fragments overlapping
asymmetry of face

Question 3

what are the indirect radiographic signs? - 3 points

Answer 3

soft tissue swelling
peri-orbital / intracranial air
fluid in paranasal sinus (usually maxillary)

Question 4

What are Dolan’s lines?
what do they follow?

why are they useful?

Answer 4

used in assessing facial bones for injury
follow the margins of the zygoma and the orbital margins of the zygoma and maxilla
useful because the zygoma = frequent site of #

Question 5

what should be looked out for in zygomatic #s?

what can help reveal an abnormal contour of the zygomatic arch?

Answer 5

look for the ‘elephant trunk’ appearance of the zygomatic arch
by comparing symptomatic side with a symptomatic side

Question 6

what are McGrigor’s lines?

Answer 6

a system for inspecting the occipito-mental view - 3 lines principle used to identify facial bone #s

Question 7

why should we check above and below the lines indicated?

Answer 7

to see if there is evidence of a fluid level/soft tissue opacity which may indicate a #

Question 8

Describe line 1 of McGrigor’s lines

What to look for - 3 points

Answer 8

s / widening of fronto-zygomatic suture / fluid level in frontal sinus

trace a line through the suture between the frontal bone and the zygomatic bone at the lateral margin of the orbit, follow across the forehead assessing the superior orbital margin and the frontal sinus, continue on other side of radiograph following the same landmarks

Question 9

Describe line 2 of McGrigor’s lines

What to look for - 2 points

Answer 9

trace a line upwards along the superior border of zygomatic arch crossing the body of zygoma, continue onto inferior margin of the orbit and over the bridge of the nose, follow same landmarks onto the other side of the face
#s of zygomatic arch, # through inferior rim of orbit

Question 10

Describe line 3 of McGrigor’s lines

What to look for - 2 points

Answer 10

trace a line along the inferior margin of the zygomatic arch, down the lateral wall of maxillary antrum, continue along the inferior margin of the antrum, across the maxilla, including the roots of the upper teeth
#s of zygoma and lateral aspect of the maxillary antrum, fluid levels

Question 11

what are advantages of the OM30 view - 3 points

Answer 11

much more ‘tangenital’ and appears ‘distorted’
zygomatic # evident on right side of pt
orbital floor is seen in more detail from inferior perspective

Question 12

Describe the Tripod #

Answer 12

has 4 visible components
1 - widening of the zygomatic-frontal suture
2 - orbital floor #
3 - # of lateral wall of maxillary antrum
4 - zygomatic arch #

Question 13

What are the causes of a tripod #? - 4 points

what are the symptoms? - 3 points

Answer 13

personal altercations, falls, MVAs and sport injuries

Trismus (reduced jaw mobility) may results from compression of zygomatic arch on temporalis muscle and coronoid process, orbital floor disruption can result in subcutaneous emphysema, infraorbital nerve injury may result in anaesthesia or paresthesis of the cheek/nose/upper lip/lower eyelid

Question 14

what is the treatment for a tripod #?

Answer 14

non-displaced #s may be managed without surgery but need ophthalmologic exam, analgesia follow up
complex #s need to be assessed several days after injury when much of the tissue oedema has resolved - aim to gain stable, accurate reduction while minimising external scars and functional deformity
surgery can involve plating the fronto-zygomatic suture line or in more complex cases using 3 point fixation

Question 15

what is the management for a tripod #?

Answer 15

observation, antibiotics possibly steroid administration to reduce oedema and ophthalmic examinations to check diplopia (upward and far lateral gaze) - caused by muscle entrapment/nerve damage/muscle contusion - may be ongoing evidence of facial asymmetry and paresthesias

Question 16

what is a blowout #?

Answer 16

pressure anteriorly results in # of orbital wall = Buckling theory - transmission of a direct orbital rim force causes a #

Question 17

what are the causes of blowout #? - 5 points

Answer 17

result of MVAs, industrial accidents, sports-related facial trauma and assaults, in adult female population NAI in form of domestic violence

Question 18

what can blowout #s cause? - 2 points
what can blowout #s involve?
what is the trapdoor variant of the blowout #?

Answer 18

ocular motility disturbance and globe malpositioning
infraorbital nerve damage
infraorbital soft tissue (muscle/fat) may become entrapped within # as the elastic bones snap back into place resulting in potential severe restrictive optical issues

Question 19

what can be a sign of a blowout #in paediatrics?

Why do we intervene in a blow out #?

Answer 19

a relative lack of external periocular signs of trauma - white-eyed blow out #
to prevent vision loss and to minimise late problems such as persistent diplopia and disfiguring globe malpositioning

Question 20

what are the symptoms of a blowout #? - 5 points

Answer 20

diplopia - common, muscle restriction associated with peri-muscular tissue entrapment at #, severe epistaxis, CSP leakage and lacrimal drainage problems, orbital roof #s can be associated with intracranial injury
TEARDROP SIGN

Question 21

what is the treatment for a blowout #? - 6 points

Answer 21

oral antibiotics likely to be administered as #s cause laceration of the sinus mucosa, analgesia and antiemetrics may be required, use of oral steroids to decrease soft tissue oedema
surgical repair involves reduction and rigid fixation with replacement of lost/comminuted bone, possible lens implants and reconstruction of orbital wall with cancellous bone grafts

Question 22

what is the management for a blowout #?

Answer 22

diplopia, muscle and nerve damage should be monitored for at least 6 months

Question 23

what is an orbital blowout # usually accompanied by?

Answer 23

fluid level in the maxillary antrum

Question 24

describe orbital emphysema

where does the air come from?

Answer 24

air has leaked into the orbit and is sometimes referred to as the ‘eyebrow’ sign, air rises into the most superior aspect of the orbit, almost always in the context of a facial # in a linear fashion, giving the appearance of an eyebrow
comes from either the maxillary or ethmoid sinus after a #