2.  45yo F restrained passenger
of MVC auto vs 18 wheeler.
+LOC. Pt was ejected from
the vehicle. Unable to open
eyes 2/2 facial swelling. Also
c/o back pain
 T 97 HR 105 BP 100/60 RR
16 po2 95% on nrb
 GEN: significant contusions,
edema and dried blood to
face
 HEENT: PERRLA, EOMI, b/l
ecchymosis to eyes, edema
b/l over maxilla and nasal
bridge
 MSK: TTP in L4/L5
 Neuro: GCS 12

4. 1.Arrowheads: Bilateral Maxillary Sinus Air Fluid Levels
2.Arrows: Fractures of Lateral Walls of Maxillary Sinus

5. Airway
 May Require Intubation
Evaluate for associate injuries
 Intracranial, spine, thoracic, abdominal
Visual Acuity
 May need optho consult
Admit
 Surgery Consult
 Open Reduction/Internal Fixation

6. Physical Exam
 Hard Palate/Upper Teeth Move
Fracture Components
 Pterygoid Processes Fractured
 Anterolateral nasal fossa above maxillary aveolar ridge
(med/lat walls of max sinus)
Fracture line
 Between maxillary floor and orbital floor
Combination of Le Fort patterns common

7. Air Fluid Level
Bilateral Pterygoid
plate fx
B/L max
sinus wall fx

8.  Tintanelli’s Emergency Medicine: A Comprehensive Study
Guide. Chapter 257 Maxillofacial Trauma
http://www.rad.washington.edu/academics/acade
mic-sections/msk/teaching-materials/onlinemusculoskeletal-radiology-book/facial-andmandibular-fractures
 Rhea, J. How to Simplify the CT diagnosis of LeFort
Fractures.AJR, 2005.184: 1700-1705