This document provides an outline and discussion of imaging approaches for facial trauma, including fractures of the maxilla and mandible. It describes various types of maxillary fractures such as sagittal, alveolar process, and LeFort fractures. LeFort fracture types I, II, and III are defined based on the anatomical structures involved. Examples of maxillary sagittal, alveolar process, LeFort I and II fractures are shown through imaging case studies. The document concludes with an overview of mandibular fractures and their clinical presentation.
This presentation covers routinely used intraoral & extraoral plain radiographs used in assessment of maxillofacial trauma patients with extended coverage on occlusal radiographs. This PPT is echanced with addition of images for all radiographs
Jaw lesion radiology ppt ppt . This powerpoint presentation includes important anatomy, radiographs and important pathology of jaw lesion with its imaging feature as well as its Xray ct mri image. This will help alot. this will help for radiology resident as well as ent resident and event dentist.
This presentation covers routinely used intraoral & extraoral plain radiographs used in assessment of maxillofacial trauma patients with extended coverage on occlusal radiographs. This PPT is echanced with addition of images for all radiographs
Jaw lesion radiology ppt ppt . This powerpoint presentation includes important anatomy, radiographs and important pathology of jaw lesion with its imaging feature as well as its Xray ct mri image. This will help alot. this will help for radiology resident as well as ent resident and event dentist.
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.
lefort fractures are an important set of fractures to learn among midfacial fractues which requires a thorough anatomical knowlwdge for adequate management of patient as they suffer from mild to severe aesthetic deformities in addition to functional compromise which needs to be corrected with precise knowledge and care
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
IZC Bone Screw Anchorage for Conservative Treatment of Bimaxillary Crowding i...ALFREDO NOVOA VASQUEZ
UN EXCELENTE ARTICULO DEL DR. CRIS CHANG.
USO DE LOS MINIIMPLANTES INFRAZIGOMÁTICOS PARA EL TRATAMIENTO DE UNA CLASE II -1 / SUBDIVISION 1 ASIMETRICA CON APIÑAMIENTO BIMAXILAR.
IZC Bone Screw Anchorage for Conservative Treatment of Bimaxillary Crowding in an Asymmetric Class II/I Subdivision 1 Malocclusion
Drs. Chang MJ, Lin JJ, Roberts WE.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- 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
- Prix Galien International Awards Ceremony
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
1. Imaging of Facial Trauma
Part 2: Pathology (Cont’d)
Rathachai Kaewlai, MD
Specialized in Body Imaging and Emergency Radiology
rathachai@gmail.com
January 2007
The author is willing to receive any input, comments and corrections,
Please do not hesitate to contact at the email address provided above. 1
Emergency Radiology: Imaging of Facial Trauma
2. Outline
• Facial and mandibular fractures
– Maxillary fractures
• Maxillary sagittal fracture
• Alveolar process fracture
• LeFort fractures
– Mandibular fractures
• Imaging approach
– Plain film
– CT
2
Emergency Radiology: Imaging of Facial Trauma
3. Maxillary Fractures
• Types of maxillary fractures
– Maxillary sagittal fracture (maxillary sinus fracture)
– Palate fracture
– Alveolar process fracture
– LeFort fractures
• LeFort I fracture
• LeFort II fracture
• LeFort III fracture
• Combination (bilateral, hemi)
3
Emergency Radiology: Imaging of Facial Trauma
4. Maxillary Fractures
• Maxillary sagittal fracture
– AKA maxillary sinus fracture
– Fracture of a maxilla in sagittal plane, involving anteriorlateral wall
of a maxillary sinus (LeFort fractures represent bilateral maxillary
fractures)
– Due to direct blow to either right or left midface
– Plain film shows opacified maxillary sinus
4
Emergency Radiology: Imaging of Facial Trauma
5. Maxillary Sagittal Fracture
68yearold man was found down.
There is a sagittal plane fracture of the left maxillary sinus (red arrow)
with hemosinus (H)
5
Emergency Radiology: Imaging of Facial Trauma
6. Maxillary Fractures
• Isolated alveolar process fracture
– Fracture of any portion of the alveolar process
– Clinically evident by malalignment and displacement of teeth
contained within fractured segment
– Even on CT, fracture may be subtle and easily overlooked
– Further imaging may be needed when the diagnosis is made
• Xray of the teeth or a panoramic view (look for dental injuries)
• Chest radiograph (look for aspirated teeth)
6
Emergency Radiology: Imaging of Facial Trauma
7. Maxillary Alveolar Process Fractures
Middle age women fell onto her mouth.
Red arrows show the comminuted fractures of the maxillary alveolar process
on the right side. These fractures are considered ‘open’ as they are
connected to the oral cavity.
7
Emergency Radiology: Imaging of Facial Trauma
8. LeFort Fractures
• Among the most severe fractures seen in face and
associated with highenergy trauma
• Named after René LeFort, a French physician, who studied
facial fractures in cadavers. Result was published in 1901
• Key facts
– In each type, there is a partial or complete separation of maxilla
from the remainder of the facial skeleton
– All LeFort fractures must extend through posterior face,
transects the pterygoid processes
– Any combination of LeFort I, II, and III patterns can occur
8
Emergency Radiology: Imaging of Facial Trauma
9. LeFort Fractures
• LeFort I fracture
– Definition: transmaxillary fracture
– Transverse (horizontal) fracture of inferior maxillae, involving
maxillary sinuses (all except superior walls), lateral margin of nasal
fossa, nasal septum and pterygoid plates
– Clinical: free floating and movable hard palate with maxillary teeth
– Imaging findings
• Opacified bilateral maxillary sinuses
• Transverse fracture through the inferior maxillae above hard palate
• Best shown and confirmed by coronal and sagittal reformatted CT
images
9
Emergency Radiology: Imaging of Facial Trauma
10. LeFort I Fracture
48yearold man was kicked by a horse.
LeFort I fracture line along bilateral maxillary sinuses (red arrows). Pterygoid plate fractures are
present (not shown). Blue arrow indicates right mandibular fracture.
H = Hemosinus
10
Emergency Radiology: Imaging of Facial Trauma
11. LeFort Fractures
• LeFort II fracture
– Pyramidshaped maxillary fracture, involving maxillary sinuses
(anteriorlateral walls), inferior orbital rim, orbital floor and
nasofrontal suture
– Clinical: free floating, movable midface including maxillary teeth,
hard palate and nose
– Imaging findings:
• Opacified bilateral maxillary sinuses and orbital emphysema
• Fractures of anterior/lateral walls of maxillary sinuses, inferior orbital
rims/floors and disruption of nasofrontal suture
• Best seen and confirmed by coronal reformatted CT images
11
Emergency Radiology: Imaging of Facial Trauma
12. LeFort II Fracture
Middle age man in motor vehicle collision.
Fracture lines are demonstrated in red arrows.
Fracture of pterygoid plates are present in all
type of LeFort fractures, they are best seen in
coronal images.
H = Hemosinus
12
Emergency Radiology: Imaging of Facial Trauma
13. LeFort Fractures
• LeFort III fracture
– AKA craniofacial disjunction
– This fracture separates calvaria (skull) from the facial bones
– Most severe LeFort fracture
– Definition: separation of facial bones from the skull
• Zygomas separated from sphenoid at zygomaticosphenoid sutures
• Nasal bones and medial orbital walls separted from frontal bone at
nasofrontal sutures
• Best seen in coronal images
– Clinical: movement of face relative to the skull
– Imaging findings:
• Plain film will underestimate degree of injury due to severe soft tissue
swelling obscuring the bony details. CT is recommended
13
Emergency Radiology: Imaging of Facial Trauma
14. Combined LeFort II and
III Fractures
32yearold man, unrestrained
driver in a motor vehicle
accident.
Blue arrows define LeFort II
fracture. Red arrows define the
LeFort III fracture. Bilateral
pterygoid plate fractures are
present (not shown).
14
Emergency Radiology: Imaging of Facial Trauma
15. Mandibular Fractures
• Etiology
– Motor vehicle collisions + assaults: > 80% of mandible fractures
• Incidence
– Ratio of mandibular to facial fractures = 2:1
– Coexistence of mandibular and facial fractures = 610%
– Rare in children
• If occurs, condyle is the most common location
• Condyle is the growth center of mandible. Trauma to this area can
retard growth and cause facial asymmetry
• Clinical
– Laceration under chin (common)
– Pain, malocclusion, deviation of mandible on opening mouth
15
Emergency Radiology: Imaging of Facial Trauma
16. Mandibular Fractures
• Classification
– Mandible is divided into region for purpose of describing location of
fractures
• Symphysis (= within the boundaries of central incisors)
• Parasymphysis (within the boundaries of vertical lines distal to canine
teeth)
• Body (include the region of third molar)
• Angle (distal to the third molar)
• Ramus
• Condylar process (has separate classification system)
• Coronoid process
• Alveolar process (region normally contains teeth)
16
Emergency Radiology: Imaging of Facial Trauma
17. Mandibular Fractures
• Relevant anatomy
– Mandible is a ring or arc bone which is usually difficult to break in
one location. Approximately half of mandible fracture occurs in
multiple locations.
• Search for a second fracture after initial fracture has been
identified (usually at contralateral side)
– In symphyseal, parasymphyseal fractures: Digastric, geniohyoid
and genioglossus muscles pull the symphysis downward posteriorly
– In angle fracture: 3 muscles attaching to the ramus of mandible
(masseter, temporalis and medial pterygoid) pull the proximal
fragment upward and medially
17
Emergency Radiology: Imaging of Facial Trauma
18. Mandibular Fractures
• Imaging recommendation
– Plain film mandible series (PA, lateral, Towne’s and bilateral
obliques) show nearly all fractures BUT may be difficult to obtain in
multitrauma patients
– Panoramic radiography (orthopantogram)
• Need patient in upright position
• Not optimal as a single radiograph to detect mandibular fracture
• Better to look for subtle tooth fracture
– CT
• Show all mandibular fractures AND other facial fractures (co
existence 610%), as well as position and alignment of fragments
• Display associated soft tissue injuries
• Easy to perform in multitrauma patient
18
Emergency Radiology: Imaging of Facial Trauma
19. Mandibular Fractures: Missed
by Mandibular Series
Full mandible series fail to recognize
fracture/dislocation later shown in CT scan.
Red arrows = Mandibular condyles which are located
‘too anterior’ than usual
19
Emergency Radiology: Imaging of Facial Trauma
20. Mandibular Fractures: Missed by Mandibular Series
Same patient as in previous page. If plain film is too be used,
CT shows left symphyseal/ parasymphyseal fracture extending to the make sure to have all
tooth (green arrows), and bilateral mandibular condyle fractures (red projections, adequate
arrows). The findings represent ‘Flail mandible’.
coverage and optimal
Limitation of plain films in previous page is likely due to 1. Inadequate
coverage (PA projection does not include the inferior part of mandible) technique. If in doubt, CT
2. Suboptimal technique (Oblique views are not true oblique) is the solution
20
Emergency Radiology: Imaging of Facial Trauma
21. Mandibular Fractures
43yearold man, fell from height, presented with Search for second site
malocclusion of fracture is
Orthopantogram demonstrates a fracture of the right warranted when one
ramus of mandible (red arrows). Subtle ‘second’ site of
sees mandibular
fracture is at the left body (green arrows) with missing
tooth ADA #19 which is confirmed in CT scan (next fracture
page).
21
Emergency Radiology: Imaging of Facial Trauma
22. Right Sagittal
Mandibular Fractures
Same patient as in previous page.
CT confirms the fractures of the right angle of mandible (red arrows) and left body (green
arrows). Axial image shows extension of fracture into the root of the left mandibular
tooth, indicating an open fracture
22
Emergency Radiology: Imaging of Facial Trauma
23. Mandibular Fractures Missed by Orthopantogram
21yearold man was punched at his left face by the righthanded.
Orthopantogram shows a nondisplaced fracture of the left angle of mandible (red
arrows), extending to the root of unerupted ADA #18.
Where is the second site of fracture?
23
Emergency Radiology: Imaging of Facial Trauma
24. Mandibular Fractures Missed by Orthopantogram
Same patient as previous page.
CT Orthopantogram (postprocessing images from axial CT) shows an additional
nondisplaced fracture of the left parasymphysis (blue arrows).
Plain orthopantogram should not be used as a single imaging to look for
mandibular fractures. It is useful for tooth fracture, not for mandible.
24
Emergency Radiology: Imaging of Facial Trauma
25. A B
Mandibular Fractures with TMJ Dislocation
19yearold woman in a rollover motor vehicle collision.
Axial CT image (A) shows ‘empty glenoid sign’ (red line) indicating right temporomandibular joint
dislocation. Image B (inferior to A) revealed a fracture of the right mandibular condyle (red arrow)
with anterior medial displacement of the condyle due to the pull of lateral pterygoid muscle. The
left glenoid fossa is normal.
C = Left condyle of mandible
25
Emergency Radiology: Imaging of Facial Trauma
26. Mandibular
Fractures with TMJ
Dislocation
Same patient as in previous
page.
3D reconstruction image
on right lateral view
makes it easier to
understand the fracture
site, dislocation and
orientation of the
fragment.
Red arrows = fracture of the
base of right condyle of
mandible
26
Emergency Radiology: Imaging of Facial Trauma
27. Mandibular Fractures with Tooth Fracture
Young man in a motor vehicle accident.
Tooth fracture of ADA #29 is apparent (blue arrow) in this orthopantogram. However,
fracture of the right body of mandible is very subtle (red arrow) and may be detected
only retrospectively. This confirms that orthopantogram is not an appropriate
imaging technique to rule out or characterize mandible fractures.
27
Emergency Radiology: Imaging of Facial Trauma
28. Mandibular Fractures with Tooth Fracture
Same patient as in previous page.
In this case, CT demonstrates comminuted fracture of the right body of mandible
(red arrow) and tooth fracture (blue arrow). With tooth fracture, orthopantogram and
dedicated tooth radiograph are an appropriate and optimal technique.
28
Emergency Radiology: Imaging of Facial Trauma
29. Imaging Approach Plain Film
• Friendly line (anterolateral antral wall of maxillary sinus)
– Both intact
• NO ZMC or LeFort fractures
• Blowout fracture
• Isolated fractures of lateral orbital wall, zygomatic arch
– One disrupted
• ZMC fractures
• Maxillary sagittal fracture (isolated sinus fracture)
– Both disrupted
• LeFort fractures
29
Emergency Radiology: Imaging of Facial Trauma
30. Imaging Approach CT
• Clear sinus sign (= all sinuses and mastoid are clear of fluid)
– Nasal bone fractures
– Isolated zygomatic arch fractures
– Orbital roof/lateral wall fractures
– Mandible fractures
• Hemosinuses
– Pterygoid plate fracture present probable LeFort fracture
• With fracture of lateral margin of nasal fossa = LeFort I
• With fracture of inferior orbital rim = LeFort II
• With fracture of zygomatic arch = LeFort III
– Maxillary wall fractures
– Orbital floors, NOE region fractures
– ZMC fractures
30
Emergency Radiology: Imaging of Facial Trauma
31. Checklist for Facial Radiograph/CT
Treat lifethreatening injury first (ABC of trauma)
CT is more accurate, faster to do than plain film and can be
performed at the same time as trauma head CT
Emergency in face injury
Airway compromise due to severe soft tissue swelling,
fracture or obstructed foreign body
Life threatening hemorrhage can be from nasal injury
Facial fractures that compromise vision
Orbital apex fracture may injure optic nerve, requiring urgent Rx
Entrapment of intraocular muscle requires urgent Rx
31
Emergency Radiology: Imaging of Facial Trauma
32. Checklist for Facial Radiograph/CT
Facial structures are quite symmetrical
Do not stop searching when see one abnormality
If suspect for more than simple nasal fracture, do CT
Significant (but can be subtle) fractures
Fracture involves the optic foramen which can cause permanent
visual loss if not treated promptly
Fracture of the posterior wall of frontal sinus requires
neurosurgical evaluation and may require antibiotics prophylaxis
Fracture/dislocation of the TMJ usually missed on initial survey. It
can cause significant disability if left untreated
Look for significant soft tissue injuries
Globe rupture, hemorrhage
32
Emergency Radiology: Imaging of Facial Trauma
33. • The information provided in this presentation…
– Does not represent the official statements or views of the Thai
Association of Emergency Medicine.
– Is intended to be used as educational purposes only.
– Is designed to assist emergency practitioners in providing
appropriate radiologic care for patients.
– Is flexible and not intended, nor should they be used to establish a
legal standard of care.
33
Emergency Radiology: Imaging of Facial Trauma