Skull and Face Trauma

Question 1

CT scanning with or without…contrast is used in most ED to evaluate head
injury?

Answer 1

without

Question 2

Basic radiographic views of the skull:

Answer 2

• PA Caldwell
• AP Towne
• B/L laterals
• PA Water’s

Question 3

which view may assist in investigation of pathology of the paranasal
sinuses?

Answer 3

PA Water’s

Question 4

80% of skull fractures

Answer 4

Linear skull fracture
(tends to
cross sutures)

Question 5

Linear skull fracture M/C found in which bones?

Answer 5

parietal and temporal

Question 6

both inner and outer table of the cranial bones are

involved

Answer 6

Linear skull fracture

Question 7

Unlike suture lines, linear fractures will not show

Answer 7

serrated edges

Question 8

considered an open fracture
(15% of
all skull fractures)

Answer 8

Depressed skull fracture

Question 9

due to high energy impact, depressed skull fracture are almost always in

Answer 9

cranial vault bones

Question 10

Best modality for Dx of depressed skull fracture?

Answer 10

CT scanning

Question 11

If depressed fragments extend > ____ cm, neurosurgical referral is
crucial.

Answer 11

0,5-1

Question 12

complications from depressed skull fracture

Answer 12

• Epidural, subdural and subarachnoid hemorrhage
• Meningitis
• Pneumocephalus & CSF leak

Question 13

skull bones of a new born infant may fracture without

osseous and periosteal break, similar to “green stick” fracture

Answer 13

Ping-Pong (pond) skull fracture

Question 14

may develop during labour or from

postnataly trauma

Answer 14

Ping-Pong fracture

Question 15

continuous smooth inward indentation of the skull

calvaria

Answer 15

Ping-Pong fracture

Question 16

diagnosis of sutural diastasis

Answer 16

• at birth > 1-cm
• age 2->3-mm
• age 3->2-mm

Question 17

pathology that may separate normal sutures:

Answer 17

• Raised
ICP/Hydrocephalus
• Neuroblastoma
• Leukemic and lymphoma cells infiltration

Question 18

Often better identified clinically than radiographically

Answer 18

basilar fracture

Question 19

Radiographic signs of _________ can be very subtle or not

seen at all

Answer 19

basilar fracture

Question 20

Sphenoid and temporal bones may be involved in >75% cases with
complete or partial obscuration of the sphenoid sinus

Answer 20

basilar fracture

Question 21

Tearing of the meninges is common

Answer 21

basilar fracture

Question 22

CSF rhinorrhea and/or otorrhea, Battle sign and Raccoon

eyes sign can be observed in what fracture?

Answer 22

basilar fracture

Question 23

basilar fracture has high probability of

Answer 23

intracranial hemorrhage and meningitis

Question 24

best modality for basilar fracture

Answer 24

CT scanning

Question 25

may develop rapidly with acute rise in | intracranial pressure,

Answer 25

Epidural (extradural) hematoma

Question 26

epidural hematoma involves what artery?

Answer 26

middle meningeal

Question 27

subdural hematoma involves what vasculature?

Answer 27

bridging veins

Question 28

Leptomeningeal cyst, also called a?

Answer 28

growing fracture

Question 29

growing fractures are most found in

Answer 29

pediatric skull < 3 years old

Question 30

Develops due to meningeal tear and interposition of leptomeninges and CSF with or w/o cerebral parenchyma

Answer 30

Leptomeningeal cyst (growing fracture)

Question 31

Leptomeningeal cyst may lead to?

Answer 31

seizures, hydrocephalus, meningitis

Question 32

Most common of all facial bone fractures (>45%) and can be missed d/t large regional swelling

Answer 32

nasal fracture

Question 33

nasal fracture aften present with what othe fracture?

Answer 33

blow-out (orbital)

Question 34

Conventional radiographs may show ___ sensitivity

Answer 34

80% ((lateral nasal view)

Question 35

may lead to difficulty breathing nasally

Answer 35

Displaced fractures

Question 36

result of sudden impact to the globe

Answer 36

Blow-out fracture

Question 37

Most cases will result in infra-orbital fracture that will force orbital fat and sometimes inferior rectus (IR) muscle into which sinus?

Answer 37

``` maxillary sinus (occasionally IR may be trapped-”trapped-door” fracture) ```

Question 38

50% of blow-out fractures may involve fracture of the

Answer 38

medial wall (lamina papyrecea)

Question 39

CT helps to exclude complications in blow-out fracture such as

Answer 39

optic nerve injury or trapped IR | muscle (trapped-door)

Question 40

Water’s skull view may show opacification of the

Answer 40

maxillary sinus

Question 41

2nd m/c facial fracture after nasal fracture

Answer 41

Tripod Fracture

Question 42

40% of mid face | fractures

Answer 42

Tripod Fracture

Question 43

m/c mechanism for Tripod Fracture is a blow to

Answer 43

malar region of the face

Question 44

Specific tripod fracture points:

Answer 44

1) zygomatic arch 2) orbital process of zygomatic bone and superior-lateral maxillary sinus wall 3) maxillary process of zygomatic bone

Question 45

Complications of tripod fracture?

Answer 45

trismus, trapped temporalis muscle, loss of sensory | distribution along maxillary (V2) nerve distribution

Question 46

Conventional radiographs for tripod fracture?

Answer 46

Water’s view (CT is better)

Question 47

Complex fracture of the mid face that potentially separates mid facial structure from the skull base

Answer 47

LeFort Fracture

Question 48

to diagnose LeFort | fracture, Involvement of the _______ is essential

Answer 48

pterygoid plate

Question 49

horizontal maxillary fracture.... producing separation of the upper teeth from the face, passing through the alveolar ridge, lateral nose and inferior wall of maxillary sinus

Answer 49

LeFort 1

Question 50

pyramidal-shaped fracture.... with the upper teeth at the base and the nasal-frontal suture at the apex, passing through posterior alveolar ridge, lateral maxillary sinus wall, inferior orbit and nasal bones

Answer 50

LeFort 2

Question 51

cranial-facial separation,..... fracture passing through nasalfrontal suture, maxilla-frontal suture, orbital wall and zygomatic arch

Answer 51

LeFort 3

Question 52

Common facial fracture that in most cases due to assault

Answer 52

Mandibular Fractures

Question 53

thought to represent a ring of bone that is connected to | the base of the scull by the TMJ.

Answer 53

mandible

Question 54

Most mandibular fractures seem to be

Answer 54

unilateral (>45% cases)

Question 55

involved >30% and is considered one of | the most common location of mandibular fractures

Answer 55

Mandibular condyle