[Emergency] Atlas of Head and Facial trauma

Atlas of Head and Facial trauma, Emergency, Fourth Edition

Fig 1 ■ Battle Sign. Ecchymosis in the postauricular area
develops when the fracture line communicates with the mastoid air
cells, resulting in blood accumulating in the cutaneous tissue. This
patient had sustained injuries several days prior to presentation.

Fig 2 ■ Battle Sign. A striking Battle sign is seen in this
patient with head trauma. This finding may take hours to days to
develop.

Fig 3 ■ Raccoon Eyes. Acute periorbital ecchymosis seen in
this patient with a basilar skull fracture. These findings may also be
caused by facial fractures.

Fig .4 ■ Early Raccoon Eyes. Subtle periorbital ecchymosis
manifests 1 hour after a blast injury.

Fig 5 ■ Hemotympanum. Seen in a basilar skull fracture
when the fracture line communicates with the auditory canal, resulting in
bleeding into the middle ear. Blood can be seen behind the tympanic membrane.

Fig.6 ■ CT of Basilar Skull Fracture. CT bone
window demonstrates a fracture of the posterior wall left sphenoid sinus

Fig 7 ■ Halo Sign—Cerebrospinal Fluid Leak. Otorrhea on bed sheet demonstrating a halo sign from a patient with severe head trauma. The distinctive double-ring sign, seen here, comprises blood (inner ring) and CSF (outer ring). The reliability of this test has been questioned.  

Fig 8 ■ Depressed Skull Fracture. A scalp laceration overlying a depressed skull fracture. Scalp lacerations should undergo sterile exploration for skull fracture.

Fig 9 ■ Depressed Skull Fracture. CT demonstrating
depressed skull fracture.  

Fig 10 ■ Ping Pong Ball Skull Fracture. (A) Akin to the greenstick fracture, a ping pong ball fracture occurs when a newborn or infant’s relatively soft skull is indented by the corner of a table or similar object without causing a frank break in the bone. (B) CT demonstrates the ping pong ball effect.

Fig 11 ■ Nasal Fracture. Deformity is evident on examination. Note periocular ecchymosis indicating the possibility of other facial fractures (or injuries). The decision to obtain radiographs is
based on clinical findings. A radiograph is not indicated for an isolated
simple nasal fracture.  

Fig 12 ■ Septal Hematoma. A bluish, grapelike mass on the
nasal septum. If untreated, this can result in septal necrosis and a
saddle-nose deformity. An incision, drainage, and packing are indicated.  

Fig 13 ■ Saddle-Nose Deformity. Nasal septal necrosis resulting in saddle-nose deformity.  

Fig 14 ■ Open Nasal Fracture. Lacerations with underlying fracture that require multilayer closure that should be repaired by a facial surgeon and require antibiotics.

Fig 15 ■ Minimally Displaced Nasal Fracture. Plain
radiograph of a fracture of the nasal spine.

Fig 16 ■ Comminuted Nasal Fracture. CT demonstrates a
comminuted nasal bone fracture.  

Fig 17 ■ Zygomatic Arch Fracture. Axial cut of a facial CT
which reveals a minimally depressed zygomatic arch fracture.

Fig 18 ■ Zygomatic Arch Fracture. Patient with blunt
trauma to the zygoma. Flattening of the right malar eminence is
evident.

Fig 19 ■ Tripod Fracture. The fracture lines involved in
a tripod fracture are demonstrated in this three-dimensional CT
reconstruction.

Fig  1.20 ■ LeFort Fractures. Illustration of the fracture lines
of LeFort I (alveolar), LeFort II (zygomatic maxillary complex), and
LeFort III (cranial facial dysostosis) fractures.  

Fig 21 ■ LeFort Facial Fractures. Patient with blunt facial
trauma. Note the ecchymosis and edema. This patient sustained a left
LeFort II fracture and a right LeFort III, and intracranial hemorrhages.

Fig 22 ■ LeFort Facial Fractures. Patient with blunt
facial trauma who demonstrates the classic “dish face” deformity
(depressed midface) associated with bilateral LeFort III fractures.

Fig 23 ■ Orbital Floor Fracture. Sustained from blunt
trauma to infraorbital rim causing buckling of the orbital floor.
Facial CT is similar to that in Fig. 1.25. Infraorbital hypesthesias
and lack of entrapment suggest the buckling mechanism of injury.

Fig 24 ■ Inferior Rectus Entrapment. The right inferior
rectus muscle is entrapped within this orbital floor fracture limiting
upward gaze.

Fig 25 ■ Orbital Floor Fracture with Entrapment. Coronal
CT of the patient in Fig. 1.24 demonstrating the entrapped muscle
extruding into the maxillary sinus.

Fig 26 ■ Medial Wall Orbital Fracture. Periorbital ecchymosis and swelling is seen in this patient with a medial wall orbital fracture. The patient blew her nose after the injury and the swelling became more prominent.

Fig 27 ■ CT of Medial Wall Orbital Fracture. Coronal CT
of the patient in Fig 26. Subcutaneous emphysema and orbital air
is seen. An opening between the orbit and ethmoid air cells can be seen.

Fig 28 ■ Mechanisms of Orbital Wall Injury. (A) True “blowout” mechanism where all energy is transmitted to globe. (B) Buckle injury where energy is transmitted to inferior orbital rim, causing a buckling of the orbital floor.  

Fig 29 ■ Open Mandibular Fracture. An open fracture is suggested by the misaligned teeth and gingival disruption.  

Fig 30 ■ Sublingual Hemorrhage. Hemorrhage or ecchymosis in the sublingual area is pathognomonic for mandibular fracture.

Fig 31 ■ Bilateral Mandibular Fracture. The diagnosis is
suggested by the bilateral ecchymosis seen in this patient.

Fig 32 ■ Favorable Mandibular Fracture. Dental panoramic
view showing two nondisplaced mandibular fractures that are
amenable to conservative therapy.  

Fig 33 ■ Unfavorable Mandibular Fracture. Dental
panoramic view demonstrating a mandibular fracture with obvious
misalignment due to the distracting forces of the masseter muscle.

Fig 34 ■ Mandibular Fractures. Axial (A) and coronal (B) views of a maxillofacial CT reveal a right mandibular body and a parasymphyseal fracture.  

Fig 35 ■ Classification of Mandibular Fractures. Classification based on anatomic location of the fracture.

Fig 36 ■ Pinna Contusion. Contusion without hematoma
is present. Reevaluation in 24 hours is recommended to ensure a
drainable hematoma has not formed  

Fig  1.37 ■ Pinna Hematoma. A hematoma has developed,
characterized by swelling, discoloration, ecchymosis, and flocculence. Immediate incision and drainage or aspiration is indicated, followed by an ear compression dressing.  

Fig 38 ■ Cauliflower Ear. Repeated trauma to the pinna
or undrained hematomas can result in cartilage necrosis and subsequent deforming scar formation.  

Fig 39 ■ Complete Avulsion of Partial Pinna. This ear
injury, sustained in a fight, resulted when the pinna was bitten off.
Plastic repair is needed. The avulsed part was wrapped in sterile
gauze soaked with saline and placed in a sterile container on ice.  

Fig 40 ■ Partial Avulsion of Pinna. Partial avulsion of the
pinna seen at its superior junction with the scalp. Cartilage exposure
and injury prompts ENT consultation for repair.

Fig 41 ■ Complete Avulsion of Entire Pinna. This injury
occurred as a result of a motor vehicle crash. The pinna was not
found.

Fig 42 ■ Frontal Laceration. Any laceration over the frontal
sinuses should be explored to rule out a fracture. This laceration was
found to have an associated frontal fracture.  

Fig 43 ■ Frontal Sinus Fracture. Fracture defect seen at the
base of a laceration over the frontal sinus.  

Fig 44 ■ Frontal Sinus Fracture. Fracture of the outer table of the frontal sinus is seen under this forehead laceration.

Fig 45 ■ Frontal Sinus Fracture. CT of the patient in
Fig 42 demonstrating a fracture of the anterior table of the frontal
sinus.  

Fig 46 ■ Traumatic Exophthalmos. (A) Blunt trauma
resulting in periorbital edema and ecchymosis, which obscures the
exophthalmos in this patient. The exophthalmos is not obvious in
the AP view and can therefore be initially unappreciated. (B) The
same patient viewed in the coronal plane from over the forehead
demonstrating right eye exophthalmos.

Fig 47 ■ Retrobulbar Hematoma. CT of the patient in
Fig. 46 with right retrobulbar hematoma and traumatic exophthalmos.

Fig 48 ■ Traumatic Exophthalmos. Proptosis, hyphema,
periorbital ecchymosis, and marked swelling in the patient with a
retrobulbar hematoma from severe head and face trauma. Examination findings
are more obvious than Fig. 46.

Fig 49 ■ Traumatic Exophthalmos. Anterior globe dislocation due to
high energy facial trauma. There is no retrobulbar hematoma in this patient

Fig 50 ■ Traumatic Enucleation. Complete enucleation of the right eye after a mechanical fall and hitting their face on the corner of a table. Family came with the patient with the eye in a plastic bag. No other injury is seen on orbit CT scan.

Fig .51 ■ Facial Zones of Injury.  

Fig 52 ■ Midface Injury. A jackhammer bit is lodged into the
right maxillary sinus.

Fig 53 ■ Midface Injury Radiograph. Plain film of patient
in Fig. 1.52. CT confirmed no other injury. Projectile was removed in
the OR.

Fig 54 ■ Herniation Syndromes. a. Subfalcine; b. uncal;
c. central transtentorial; d. external; e. cerebellotonsillar.  

Fig 55 ■ Ipsilateral Dilated Pupil due to Uncal Herniation.
CT revealed an epidural hematoma and unilateral effacement of the
quadrigeminal cistern.  

Fig 56 ■ Normal Quadrigeminal Cistern. The normal
appearance of this CSF space is shaped like a baby’s bottom (see
arrow). It is located within two cuts superiorly of the dorsum sella

Fig 57 ■ Epidural Hematoma. A lens-shaped epidural
hematoma is seen on the left. The quadrigeminal cistern should be
seen on this slice and is completely effaced, suggesting herniation.  

Fig 58 ■ Subdural Hematoma. A crescent-shaped subdural
hematoma is seen on the left. The quadrigeminal cistern should be
seen on this slice and is completely effaced, suggesting herniation.  

Fig 59 ■ Temporal Lobe Contusion. A temporal lobe contusion is seen
on the right. The quadrigeminal cistern is partially
effaced suggesting early herniation.

This is only a part of the book : The Atlas of Emergency Medicine, Fourth Edition  of authors: Kevin Knoop (Author), Lawrence Stack (Author), Alan Storrow (Author), R. Jason Thurman (Author). If you want to view the full content of the book and support author. Please buy it here: https://goo.gl/c3M03p