Download Face fracture tips

Face fracture tips
Use sub mm cuts in orthogonal planes and 3D. Total dose for the whole face < 100 DLP, and
postoperatively can be as low as DLP 20-30.
If original cuts are malpositioned/ oblique reposition the acquired volume and reformat true axial ,
coronal and sagittal <mm cuts.
3D slices after cutting away C- spine and posterior part of the scull. Do 36 image rotations clockwise
<<< and up/ downside vvv
Report structure
Right top to bottom
Left top to bottom
Comment structures with operation indications













Frontal sinus front and posterior wall
Lateral orbital wall
Margo supra and infraorbitalis
Zygomatic arch
Maxillary sinus walls
Orbital floor / muscle impingment
Optic canal
Orbital fissures especially superior fissure
Orbital hematomas
Nose piriform aperture
Mandibular joints
Dislocations
Foreign bodies
General tips:
Fracture incices:
Fluid( blood) in sinuses or subcutaneously
Air in wrong place – in soft tissue, orbits, intracranially
Zygomatic fractures:




Lateral orbit wall
Margo infraorbital
Zygomatic arch
Orbital floor- herniation? Compute volume of herniated fat.





Maxillary sinus
General dislocation- Dorsal? Rotation? Impingment of muscle in orbit or temporal?
Orbital floor/ blow out
Orbital floor- herniation? Compute volume of herniated fat.
Medial wall? Impingment?
Le Fort 1
Upper jaw loose.




Fractured maxillary sinus walls, all of them
Pterygoid processes fractured
Septum nasi fractured
Fluid levels in both max sinus
Check Pterygoids in coronal projection.
Make sure there is a straight sagittal view and a straight lateral 3D view,
LE FORT 2:
Maxilla loose
Fraktures in:





Lamina papyracea
Orbital floors
Fractured maxillary sinus walls, the lateral ones
Pterygoid processes fractured
Fluid levels in both max sinus
Check Pterygoids in coronal projection.
Make sure there is a straight sagittal view and a straight lateral 3D view,
LE FORT 3:
Craniofacial dysjunction,
Fraktur in:




Lamina papyracea
Nasal bone/ suture
Lateral orbitt
Arcus zygomaticus
Frontal sinus



Anterior wall impression?
Posterior wall? Intracranial air? Displacement in mm?
Recesses?? ( occlusion can lead to mucocele development)
Mandibula




Often 2 or more injuries, always check contralateral side.
Teeth numbered by quadrant 1-4 and number 1-8. Tooth faces mesial, distal, lingual ,
buccal.
If injured joint check auditory canal
Mention ramus overlap, caput dislocation, size of fragments.
Scull base fractures:




Intracranial air
Blood in sphenoid sinus
Fluid in mastoids or inner ear.
Check carotid canal and optic canal!
Temporal bone fractures


Lengthwise most common. Check ossicles, geniculate ganglion
Crosswise more seldom. Check inner ear !
CAVE:
Eye muscle entrapment, orbital haematoma, optic canal carotid canal.
Associated injuries
C-spine, especially in the elderly
Brain
Viveka Rahm, Mats Beckman adaptiation