Ucsf: Video E 48 Part 7 Msk Skeletal Trauma (Learning Radiology- Facial Fractures)

Front 1

What percent of facial fractures involve the orbit

Back 1

60%

Front 2

What are 3 indirect signs of a facial fracture

Back 2

soft tissue swelling
periorbital or intracranial air
fluid in a paranasal sinus

Front 3

What is the most common facial fracture

Back 3

Nasal fracture is the most common and Zygomaticomaxillary complex (tripod fracture) fracture is the second most common

Front 4

What is the third most common fracture

Back 4

LeFort (35%)
I 15 %
II 10 %
III 10 %

Front 5

What is the 4th mc facial fracture

Back 5

zygomatic arch 10%

Front 6

What is tied for 5th mc facial fracture

Back 6

Alveolar process of maxilla (5%) and Smash fractures (5%)

Front 7

What is another name of a tripod fracture

Back 7

zygomaticomaxillary complex fracture

Front 8

What does a tripod fracture involve

Back 8

separation of all three major attachments of the zygoma to the rest of the face. (think of it as removing the zygoma and therefore fractures move along the zygomaticofrontal, zygomaticomaxillary and zygomaticotemporal sutures)

Front 9

What 3 fractures make up a tripod fracture

Where exactly is the anterior wall of the maxillary sinus fractured in a tripod fracture

Back 9

the zygomatic arch (along where the zygomatic bone joins the temporal bone)
floor of the orbit and includes the maxillary sinus (anterior and posterior wall)
lateral orbital rim and wall (at the zygomaticofrontal suture)

the anterior maxillary wall is usually fractured along the zygomaticomaxillary suture

Front 10

What is the usual cause of a tripod fracture

Back 10

The tripod fracture is usually secondary to a direct blow to the malar eminence (zygoma bone)

Front 11

What does a fracture of the anterior and posterior maxillary walls look like

Back 11

there is a fracture of the anterior and posterior maxilary wall and also the zygomatic process of the temporal bone

Front 12

What does a fracture of the lateral orbital wall look like on coronal ct

What makes of the zygomatic arch

Back 12

This image shows a fracture in the area of the zygomaticofrontal suture

the zygomatic arch is formed from part of the temporal bone and a small portion of the zygoma

Front 13

What does a fracture of the zygomatic bone look like on axial ct (zygoma makes up the lateral portion of orbit and superior portion of lateral border of maxillary sinus)

What bone makes of the anterior medial and lateral and complete inferior portion of the maxillary sinus

What bone makes up the anterior lateral and a small portion of the superior lateral wall of the maxillary sinus

Back 13

This image shows the lateral orbit fracture which is the zygoma bone

maxilla

zygoma

Front 14

What makes of the floor of the orbit

Back 14

the roof of the maxillary sinus

Front 15

What is the inferior orbital rim

Back 15

the inferior portion of the front of the eye socket (front of roof of maxillary sinus)

Front 16

What makes of the floor of the orbit

Back 16

the roof of the maxillary sinus

Front 17

What is the inferior orbital rim

Back 17

the inferior portion of the front of the eye socket (front of roof of maxillary sinus)

Front 18

What are some complications of a tripod fracture
3

Back 18

impingement of the temporalis muscle, trismus (difficulty with mastication) and may compromise the infraorbital foramen/nerve resulting in hypesthesia within its sensory distribution.

Front 19

What is the mc facial fracture

Back 19

nasal fx

Front 20

Where does zygoma usually seperate from the frontal bone in a tripod fracture

Back 20

the separation of the frontal process of the zygoma from the frontal bone usually occurs in the form of a diastasis of the zygomaticofrontal suture (rememeber this the one where all its sutures are being fractured)

Front 21

Where is the malar eminence

Back 21

malar eminence is the most prominent portion of the zygoma (check bone)

Front 22

What is a common presentation of a zygomatic arch fracture

Back 22

inability to open their mouth due to impingement of the zygomatic arch fragment upon the coronoid process of the mandible or the temporalis muscle

Front 23

What is an alveolar process fracture of the maxilla

Back 23

Another focal fracture type is a fracture of the alveolar process of the maxilla, which involves a small piece of the maxilla, associated with several fractured teeth

Front 24

What is the most common cause of a blowout fracture

Back 24

The usual mechanism is a blow to the eye, with the forces being transmitted by the soft tissues of the orbit downward to the thin floor of the orbit.

Front 25

Where do bone fragments from a blow out fracture often end up going

Back 25

the maxillary sinus

Front 26

What % of blow out fractures are associated with occular injury

Back 26

24 % of these fractures are associated with ocular injury as well.

Front 27

What are 2 common pitfalls for mistaken a nasal fracture

Back 27

Common pitfalls in viewing the nasal bone are the normal sutures lining the nasal bone, as well as the linear channel for the nasociliary nerve, which may all be mistaken for a fracture

Front 28

What is the pathway of a le fort 1 fracture

Back 28

nasal septum to the lateral pyriform aperature rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction( and therefore the zygoma is not involve), continues across the inferior lateral wall of the maxillary sinus, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.

Front 29

What does a bilat pterygoid fracture look like

Back 29

Front 30

What portion of the temporal bone forms a joint with the zygomatic bone

What is medial wall of the maxillary sinus

Back 30

the zygomatic process of the temporal bone

lateral wall of the nasal cavity

Front 31

What bone is the pterygoid part of

Back 31

sphenoid

Front 32

Where is the pterygoid plates

Back 32

Front 33

Where are the pterygoids plates on the sphenoid

What does the ptyergoid plates have sutures with

Back 33

the palantine (centrally) and the maxilla laterally

Front 34

Where is the zygomaticmaxillary junction that le fort 1 goes below

Back 34

Front 35

Are le fort fractures bilateral

Back 35

yes

Front 36

How many lefort fractures are there

Back 36

three

Front 37

Describe a le fort II fracture

Back 37

Le Fort II fracture crosses the nasal bones on the ascending process of the maxilla to the medial orbital rib and then the medial orbital wall (lacrimal bone) to the medial orbital floor and crosses the inferior orbital rim. It then goes towards the maxilla just above the teeth and moves along the inferior lateral maxillary sinus like a le fort 1 fracture

Front 38

When is the only le fort fracture to break the medial and inferior orbital rib

Back 38

2

Front 39

What is a pt complication of a le fort 2 fracture

Does a le fort 1 or 2 involve the zygoma

Back 39

Because of this proximity to the infraorbital foramen, type II fractures are associated with the highest incidence of infraorbital nerve hypesthesias

no

Front 40

What is a common mechanism of a le fort 2 fracture

Back 40

A common mechanism is a downward blow to the nasal area.

Front 41

What is the most severe le fort fracture

Back 41

The most severe of the classic LeFort fracture complexes is the LeFort III

Front 42

Are pure le fort injuries common

Back 42

no

Front 43

What are some variants of le fort fractures

Back 43

Lefort I/ lefot II
Lefort II/ tripod
a mixed LeFort II/LeFort III complex
LeFort III/LeFort II/tripod complex.

Front 44

What do all three lefort fractures look like from the front

Back 44

Front 45

What does a le fort 3 look like

Back 45

Front 46

If the orbital rim is involved; what type of lefort fracture is it

Back 46

2

Front 47

What is fractured in a le fort 1 fracture

Back 47

nasal septum to the lateral pyriform aperature rims, travels horizontally above the teeth apices, crosses below the zygomaticomaxillary junction( and therefore the zygoma is not involve), continues across the inferior lateral wall of the maxillary sinus, and traverses the pterygomaxillary junction to interrupt the pterygoid plates.

Front 48

What is fractured in a le fort 2 fracture

Back 48

Le Fort II fracture crosses the nasal bones on the ascending process of the maxilla to the medial orbital rib and then the medial orbital wall (lacrimal bone) to the medial orbital floor and crosses the inferior orbital rim. It then goes towards the maxilla just above the teeth and moves along the inferior lateral maxillary sinus like a le fort 1 fracture

Front 49

What is fractured in a le fort 3 fracture

Back 49

craniofacial disjunction
fracture line passes through nasofrontal suture, maxillo-frontal suture , orbital wall and zygomatic arch.

Front 50

What does a fracture throught the anterior maxillary sinus look like

Back 50

Front 51

What does a fracture through the nasofrontal suture area look like (lefort 2)

Back 51

Front 52

If the pterygoid plate is not broken can it still be a le fort fracture

Back 52

no

Front 53

What does a lefort 1 fracture to the lateral nose look like on coronal CT

Back 53

Front 54

What part of the maxilla does a le fort 1 involve

Back 54

Fracture line: Piriform aperture, inferior lateral maxillary wall, pterygoid process of the sphenoid bone

Front 55

What is the path of le fort 2 fracture

Back 55

Le Fort II fracture crosses the nasal bones on the ascending process of the maxilla to the medial orbital rib and then the medial orbital wall (lacrimal bone) to the medial orbital floor and crosses the inferior orbital rim. It then goes towards the maxilla just above the teeth and moves along the inferior lateral maxillary sinus like a le fort 1 fracture

Front 56

What does the word antral refer to

Back 56

maxillary

Front 57

What is the piriform appeture

Back 57

the anterior end of the bony nasal opening, connecting the external nose with the skull.

Front 58

Where is the piriform aperature

Back 58

Front 59

Where is the Zygomaticofacial canal Zygomaticomaxillary suture, and Frontozygomatic suture

Back 59

Yellow arrow: Frontozygomatic suture
Orange arrows: Zygomaticofacial canal
Red arrows: Zygomaticomaxillary suture

Front 60

What is this image pointing to

Back 60

the ethmoidal grooves for the external nasal branches of the anterior ethmoidal nerves.
Comment: These grooves can be mistaken for fractures. They lie anterior to and are distinct from the nasomaxillary sutures. The nasomaxillary sutures are often fused and not visible on CT scans as in these images.

Front 61

What is the orange arrow pointing to

Back 61

In the coronal image to the left from the posterior nasal cavities, the orange arrows point to the point posterior ends of the inferior nasal conchae

Front 62

What do the yellow arrows point to

Back 62

In the coronal image to the right from the anterior nasal cavities, the gap between the yellow arrows is the right hiatus semilunaris.

Front 63

there is a bony gap in the medial wall of each maxillary sinus/lateral wall of each nasal cavity between the green arrows. What is the name of this bony gap?

Back 63

maxillary hiatus (seen posteriorly)

Front 64

What does the maxillary hiatus look like more anteriorly

Front 65

What are the fractures of a tripod fracture

Back 65

separation of all three major attachments of the zygoma to the rest of the face. (think of it as removing the zygoma and therefore fractures move along the zygomaticofrontal, zygomaticomaxillary and zygomaticotemporal sutures)

Front 66

What is the shape of the zygoma

Back 66

note that this forms 3 sutures
zygomaticomaxillary
zygomaticofrontal
zygomaticotemporal

Front 67

What bone makes up the nasal septum

Back 67

vomer inferiorly
perpendicular plate superior

Front 68

What is the fracture line of a le fort 3

Back 68

the fracture line passes to the fronto-nasal and fronto-maxillary suture (medial to the frontonasal suture) then to the lacrimal bone (the medial orbital wall) the orbital floor up to the inferior orbital fissure. From there, it extends caudally through the pterygopalatine fossa to the base of the pterygoid processes as well as from the anterior end of the inferior orbital fissure along the lateral orbital wall to the frontozygomatic fissure. The fracture of the midface is completed by the fracture of the zygomatic arch and the cranial bony part of the nasal septum.

Front 69

What are the 7 fractures of the ramus

Back 69

body, angle, condyle, symphsis, ramus, alveolar, coronoid process

Front 70

What is the mc fracture of the mandible

Back 70

body (30-40%)

Front 71

name these fractures

Back 71

1- symphsis
2- body
3-angle
4-ramus
5-ramus
6-condylar
7-coronoid process (not shown but opposite the condyle)

Front 72

What percent of pts have multiple mandibular fracture

Back 72

80% of the time (prezetel bone)

Front 73

Where do double fractures typically occur

Back 73

When double fractures occur, they are usually on contralateral sides of the symphysis.