This document discusses skull and facial fractures. It begins by defining a fracture as a partial or complete break in the skull bone, usually from direct impact, indicating substantial force was applied to the head. It then describes the anatomy protected by the skull - the brain, meninges, CSF. Skull fractures are more common in thin areas and develop at sites of increased force. Imaging helps assess the fracture pattern, type, extent and position. CT is usually best to evaluate skull fractures and brain injury while MRI is better for soft tissue injuries. Various fracture types - linear, depressed, basal, open vs closed - and classifications are described. Pediatric fractures like growing skull and birth fractures are additionally discussed.
Objectives of this presentation are
Introduction to ct
Cross sectional anatomy
Common important pathologies
This presentation is aimed to educate beginers to help in ct interpretetion.
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Objectives of this presentation are
Introduction to ct
Cross sectional anatomy
Common important pathologies
This presentation is aimed to educate beginers to help in ct interpretetion.
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
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Emergency Department presentation by Dr Conor Dalby. Signs and symptoms to be aware of when assessing a patient following facial injury. Common types of fractures and their management. UK.
Skull fractures are discussed with their types briefly. The treatments of the fractures are discussed as well depending on the age of the patient if patient is adult or a child. The CT Scans are also given in order to better explain and help you in understanding.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Prix Galien International 2024 Forum ProgramLevi Shapiro
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- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. What is a fracture?
• A partial or complete
break in the skull bone
and generally occurs as
a result of direct impact.
• indicates that
substantial force has
been applied to the head
and is likely to have
damaged the cranial
contents.
3. Anatomy Of The Fracture
The brain is surrounded by
1. (CSF)
2. enclosed in meningeal covering
3. and protected inside the SKULL.
The fascia and muscles
of the scalp------------------- additional cushioning
10 times more force is required to fracture a
cadaveric skull with overlaying scalp than the one
without
4. Anatomy of the fracture
The skull ------
flat bones
cranial sutures.
outer table(1.5mm)
the spongy diploe,
inner table(0.5mm)
a thick, fibrous, dura mater
shallow subdural space
arachnoid mater that covers the
surface of the brain.
• The diploë does not form where the
skull is covered with muscles, leaving
the vault thin and prone to fracture.
5. Skull fractures are more easily sustained at
• the thin squamous temporal
• parietal bones,
• the sphenoid sinus,
• the foramen magnum,
• the petrous temporal ridge,
• and the inner parts of the sphenoid wings at the skull base.
• The middle cranial fossa
• cribriform plate, the roof of orbits in the anterior cranial fossa,
and the areas between the mastoid and dural sinuses in the
posterior cranial fossa.
THE SITES AT RISK
6. • THE ROLE OF IMAGING IS TO ASSESS
THE FRACTURE
PATTERN,
TYPE,
EXTENT,
AND POSITION
THIS IS IMPORTANT IN ASSESSING THE
SUSTAINED INJURY.
7. CLASSIFICATION OF SKULLFRACTURES
Skull fractures
LINEAR
VAULT
temporal sphenoid occipital condylar cranial fossa
BASILAR
OPEN CLOSED
Longitudinal transverde mixed
ANTERIOR;cribriform MIDDLE POSTERIOR
orbital roof
DEPRESSED
9. Linear fracture
MOST COMMON
a break in the bone but
no displacement,
The fracture involves the
entire thickness of the skull.
little clinical significance
unless
involve a vascular
channel, a venous sinus
groove, or a suture.
• COMPLICATIONS include
1. EPIDURAL
HEMATOMA,
2. VENOUS SINUS
THROMBOSIS
3. SUTURE
DIASTASIS
10. Lateral skull radiograph
in a child a long, LINEAR FRACTURE extending from the midline in the occipital
region across the occipital bone into the temporal bone
11. DEPRESSED FRACTURE
The fractured segments are displaced inward, toward the
meninges and brain for more than 3 mm. (the fragment of
bone is depressed deeper than the adjacent inner table.
A high-energy transfer, such as a blow from a baseball bat
is usually comminuted
Mostly the frontoparietal region,
the bones are thin and
this part of the head is particularly prone to an
assailant's attack.
CLOSED COMPOUND/OPEN
associated with a skin laceration or when the fracture
extends into the paranasal sinuses and the middle-ear
structures
12. Compound skull fractures occur
when all layers protecting the brain
have been breached from the
meninges to the epidermis
allowing outside environmental
contact with the skull cavity
13. Sagittal CT images of an
OPEN
, COMMINUTED
,DEPRESSED SKULL
FRACTURE. Associated
Pneumocehalus (small arrows)
14. SKULL BASE FRACTURES
70% of the skull base fractures occur in the anterior fossa,
20% in the middle central skull base
5% in the middle and posterior fossa.
15.
16. IMAGING IN SKULL FRACTURES
A. Radiography
B. Computed Tomography
C. Magnetic Resonance Imaging
D. Ultrasonography
E. Nuclear Imaging
F. Angiography
20. (A) SKULL RADIOGRAPHY
.A deep black and sharply defined line.
Skull radiograph in a man shows a LINEAR
TEMPOROPARIETAL FRACTURE
21. (a) skull radiography
• False positives/negatives
FRACTURE
SUTURE
1-Greater than 3 mm in width
2-Widest at the center and narrow at the
ends
3-Runs through both the outer and the
inner lamina of bone, hence appears
darker
4-Usually over temporoparietal area
5-Usually runs in a straight line
6-Angular turns
1-Less than 2 mm in width
2-Same width throughout
3-Lighter on x-rays compared
with fracture lines
4-At specific anatomic sites
5-Does not run in a straight
line
6-Curvaceous
22. LATERAL SKULL RADIOGRAPH
left-sided fracture. across the occipital and parietal
bones.
the normal bilateral squamous
temporal sutures, not to be confused with
fractures.
23. SKULLRADIOGRAPH
in a child --------- an occipital fracture. a sclerotic
margin----------- likely to be depressed.
• example of a nonaccidental injury
24. Lateral skull radiograph
in a child - a long, LINEAR FRACTURE
running across the occipital bone.
not a vessel and not a known site for a suture.
26. Postmortem radiograph in a child with multiple fractures due to nonaccidental trauma show
A diastatic fracture of the sagittal suture.
27. --- a left-sided fracture----- courses without interruption across the occipital and parietal
bones.
28. sagittal and lambdoid sutures. None
of these are fractured,
all have serrated edges.
The sutures communicate one with
another;
they are not blind ending.
31. Importance of straight position of pt.. patient is malpositioned, both coronal sutures
are seen as separate entities. also the lambdoid sutures; . Accessory occipital sutures
are exaggerated by the patient's rotation.
32. (a) skull radiography
ADVANTAGES
Skull radiographs reveal
1. Most linear fractures,
2. Show air-fluid levels in the paranasal
sinuses and cranium,
3. And delineate the craniocervical
junction well.
33. (A) SKULL RADIOGRAPHY
• do not help in assessing intracranial
complications associated with skull fractures.
In addition,
• Temporal Bone Fractures May Be Easily
Missed.
34. THE DETECTION OF A SKULL FRACTURE
ON A RADIOGRAPH
IS REGARDED AS
AN INDICATION FOR
CT EVALUATION.
35. ADVANTAGES
• MASS EFFECT,
• VENTRICULAR SIZE AND CONFIGURATION
• BONE INJURIES,
• ACUTE HEMORRHAGE.
(B) CT SCAN:-CT scanning is the modality of choice in the evaluation of
suspected skull fractures and intracranial injury.
36. CT SCAN
an excellent modality at demonstrating
intermediate and late sequelae of head trauma,
such as
• PORENCEPHALY,
• SUBDURAL HYGROMA
• LEPTOMENINGEAL CYSTS,
• and VASCULAR COMPLICATIONS.
37. CT SCAN
• 3-D reconstructions are valuable when
evaluating facial fractures.
• Thin-section bone windows of up to 1-1.5 mm,
with sagittal reconstruction, are useful in
assessing injuries.
38. CT SCAN limitations
1. small and nonhemorrhagic lesions such
as contusion,
diffuse axonal injuries (DAIs).
2. for early demonstration of
hypoxic-ischemic encephalopathy (HIE)
39. CT SCAN
3-Temporal bone CT scanning requires
additional imaging time and patient cooperation,.
4- cannot be used to distinguish between CSF
and hemorrhage in the middle ear.
40. CT SCAN
• False positives/negatives
A linear or minimally depressed fracture may
be easily overlooked
Basilar skull fractures are difficult to
demonstrate
In patients with shearing injury of the white
matter, a CT scan may initially be normal.
41. Axial CT scan showing AN OPEN ,NON DEPRESSED, LINEAR SKULL
FRACTURE(arrow)associated with pneumocephalus(circle).
44. Coronal CT of an open, COMMINUTED, DEPRESSED SKULL FRACTURE.
The level of depression is greater than the bony table and there are a number of bone
fragments impacted below the inner cortex of the opposing bone (large arrow).
45. C.T scan in a child -------- frontoethmoid region a COMMINUTED FRACTURE in the left
frontal bone and disruption of the left orbit with air in the orbital cavity.
46. AN OPEN
COMMINUTED AND
DEPRESSED
FRONTAL BONE FRACTURE
Contusional hemorrhage in the left
frontal lobe,
S.A.H
Temporal Extradural Hematoma(red
Arrow)
A Small Pocket Of Air
The temporal horns are slightly dilated,
suggesting the development of
Hydrocephalus.
47. Axial nonenhanced c t scan of the brain shows an OPEN COMMINUTED FRACTURE
OF THE LEFT PARIETAL BONE with an underlying extradural hematoma. Air is
tracked from the scalp tissues through the fracture into the hematoma.
FRACTURES THAT
LACERATED A MENINGEAL
ARTERY,
48. Axial brain and bone-window cT scans - multiple fractures involving the right temporal and
parietal bones, with depression
49.
50. Bone-window cT scan shows a FRACTURE OF THE FRONTAL BONE.
the fluid level in the frontal sinus,----------------- that clotted blood is layering out.
51. SKULL BASE FRACTURES
• These are not always visible, but blood in the
sinus cavities (eg sphenoid sinus) suggests
their presence.
52. a fracture through the left
occipital bone
a haemorrhagic
contusion is seen in
the cerebellum
a fluid level in the
sphenoid sinus.
53. SIMPLE LINEAR
FRACTURE
of the skull base involving
the foramen magnum.this
injury pattern is concerning
for
i. associated spinal
fracture,
ii. cord injury or
iii. blunt cerebrovascular
injury
59. • If the patient has clinical evidence of skull
base fracture (eg CSF rhinorrhoea /otorrhea/
bleeding from the external auditory meatus)
• A NORMAL CT DOES NOT EXCLUDE
SUCH A FRACTURE.
60. BLEEDING FROM THE EXTERNALAUDITORY MEATUS--------- A
SIGN OF SKULL BASE FRACTURE
63. (C) MR IMAGING
LIMITATIONS
its limited availability in the acute trauma setting,
long imaging times,
sensitivity to patient motion,
incompatibility with various medical devices, and
relative insensitivity to subarachnoid
hemorrhage.
the risk of scanning patients with certain indwelling
devices (eg, cardiac pacemaker, cerebral
aneurysm clip) or foreign
64. (C) MR IMAGING
Advantages
The soft tissue detail is superior to that of CT for nonhemorrhagic
primary lesions such as contusions,
for secondary effects of trauma-------- edema and hypoxic-ischemic
encephalopathy,
and for imaging of DAI.DAI results in characteristic lesions in
increasing order of injury severity in the: 1) cerebral white matter
and gray-white matter junction, 2) corpus callosum, particularly the
splenium, and 3) dorsal upper brain stem and cerebellum
DIFFUSION SEQUENCES improve detection of acute infarction
associated with head injury.
(FLAIR) images are more sensitive than conventional MR imaging
sequences for depicting of subarachnoid hemorrhage and for lesions
bordered by CSF.
65. (C) MR IMAGING
• False positives/negatives
The sensitivity and specificity of MRI in
detecting skull fractures is low, and fractures are
easily missed.
66. (D). CEREBRAL ANGIOGRAPHY, CTA, MRA
in diagnosis and management of traumatic
vascular injuries
pseudoaneurysm,
dissection,
or uncontrolled hemorrhage
67. (E) ULTRASONOGRAPHY
Ultrasonography is a noninvasive technique
that may be useful for evaluating
• growing skull fractures
• and associated intracranial hemorrhage
in infants.
• In adults, the orbit can also be assessed for
soft-tissue injury by using sonograms.
68. (E) NUCLEAR IMAGING
• CSF rhinorrhea and otorrhea can be localized by
using overpressure cisternography with
technetium-99m (99m Tc)
diethylenetriaminepentaacetic acid (DTPA).
Single-photon emission CT (SPECT) scanning,
positron emission tomography (PET) scanning,
and transcranial Doppler ultrasonography have
complementary roles in the assessment of brain
injury.
LIMITATIONS
Cisternography with99m Tc DTPA may not be
immediately available, as this study is expensive
and cumbersome.
69. OTHER IMAGING MODALITIRS
functional imaging techniques (SPECT, PET, xenon-
enhanced CT, functional MR imaging) have a role in
assessment of cognitive and neuropsychologic
disturbances as well as recovery following head
trauma.
71. Growing skull fractures
• In some children, a fracture may remain un-
united and enlarge to form A GROWING SKULL
FRACTURE.
• SITES: calvarium, but rare sites are the
basiocciput and the orbital roof.
• various names such as A Leptomeningeal Cyst,
Traumatic Meningocele, Cerebrocranial
Erosion, Cephalhydrocele, Meningocele,
And Spuria.
72. Growing skull fractures
MECHANISM OF INJURY is usually a direct force
applied to the cranial vault, resulting in the fracture, with
tearing of the dura so that cerebrospinal fluid (CSF) leaks
to form a collection. Because the CSF is under pressure
and pulsatile, a transmitted pulsation from the
subarachnoid space into the extra-axial fluid collection
causes pressure enlargement of the fracture
CT scans, 3 types of growing skull fractures are described:
types I, II, and III.
Type I is a GSF with a LEPTOMENINGEAL CYST, which
may be seen herniating through the skull defect into the
subgaleal space.
Type II is characterized by a damaged lesion or GLIOTIC
BRAIN.
In type III, A PORENCEPHALIC CYST can be seen
73. Axial CT shows
A GROWING SKULL FRACTURE---forming the leptomeningeal cyst
75. Birth skull fractures
• occur as a complication of forceps or vacuum
extraction.
• simple parietal linear fractures,
• In some cases, associated extradural
hematoma,[4] subdural hematoma, or axonal
injury is observed.
76. Ping –pong skull fracture
• This is akin to a greenstick fracture of the long
bones in children.
• occurs in the first few months of life
• is usually caused by a fall when the skull hits the
edge of a hard blunt object, such as a table..
• The ping-pong skull fracture was first described
in a newborn whose head was impinging against
the mother's sacral promontory during uterine
contractions.
77. Lateral (CT) scanogram and axial bone-
window CT a temporal fracture.
slight inward bulging of the bone, but the
inner and outer tables are intact. A
CLASSIC PING-PONG
BALL
78. Diastatic Fractures
• when the fracture line transverses one or more
sutures of the skull causing a widening of the
suture
usually seen in infants and young children as the
sutures are not yet fused
• it can also occur in adults------------- usually
affects the lamboidal suture--------- does not fully
fuse in adults until about the age of 60.
• Sutural diastasis may also occur in various
congenital disorders such as cleidocranial
dysplasia and osteogenesis imperfecta.[
88. Le Fort II fractures. oblique fracture lines (arrows)--- through the orbital
floors,
89. Le Fort III -- fractures through the both
frontal sinuses.opacification of sinuses
(asterisks)---------------- represents blood.
Classic fracture lines extend through lateral
orbital walls (arrows)
90. • Only the Le Fort II fracture violates the orbital
rim. Because of this proximity to the
infraorbital foramen, type II fractures are
associated with the highest incidence of
infraorbital nerve hyperaesthesias.
• A Le Fort I fracture is characterized by a low
septal fracture, whereas a Le Fort II fracture
results in a high septal fracture.
91. • the Le Fort III fracture Because of their
location, are associated with the highest rate
of cerebrospinal fluid (CSF) leaks
92. Tri-pod fracture
Water's view. A fracture line is passing thru latral wall of max. sinus,orbital rim close to
infraorbital foramen,orbtal floor and zygomatic arch. The frontozygomatic suture is also
separated (open arrow)
93. Axial view. Fracture with depression of the zygomatic arch on the same side(arrow)
94. Axial CT scan demonstrating zygomaticomaxillary complex fracture on right
with severe displacement.
95. ORBITAL FRACTURES
BLOW-OUT FRACTURE
injury that results from blow to orbit
by object that is too large to enter orbit;
BLOW-IN FRACTURE
occurs when orbital floor fracture
segments herniate upward into orbit, impinging
on inferior orbital muscles or globe
96. Medial Wall and Orbital Floor Blowout Fractures
Herniation of the orbital fat,
Haemorrage in maxillary sinus
97. fracture of the bone beneath the right eye with eye
muscle tissue entrapped within the fracture (arrow).
For different imaging modalities used in case of head trauma.and according to its scale ct without contrast has been rated as the most appropriate imaging modality in case of trauma or fracture of the skull.next most appropriate is CTA head and neck with cntrast.while ---------have been rated as may be appropriate,and are selected depending upon the risks and benefits of each modality and the patients condition