Chapter 3 - Craniofacial Trauma

Question 1

Physical signs of temporal bone fracture: (3)

Answer 1

1. Hemotympanum
2. CSF otorrhea
3. Ecchymosis

Question 2

CT scan findings that should raise suspicion of temporal bone fracture: (4)

Answer 2

1. Opacification of the mastoid air cells
2. Fluid in the middle ear cavity
3. Pneumocephalus
4. Pneumolabyrunth (occasional)

Question 3

Classification of temporal bone fractures (According to orientation): (3)

Answer 3

1. Longitudinal Fracture
2. Transverse Fracture
3. Mixed fracture

Question 4

This represents 70 to 90% of temporal bone fractures

Answer 4

Longitudinal temporal bone fracture

Question 5

What are the complications of longitudinal temporal bone fractures? (5)

Answer 5

1. Conductive hearing loss
2. Dislocation or fracture of the ossicles
3. CSF otorhinorrhea
4. Facial nerve palsy (often delayed or incomplete)
5. Sensorineural hearing loss

Question 6

Transverse temporal bone fracture usually results from a blow to what area of the head?

Answer 6

Occiput or frontal region

Question 7

What are the complications of transverse temporal bone fractures? (6)

Answer 7

Usually more severe:

1. Sensorineural hearing loss
2. Severe vertigo
3. Nystagmus
4. Perilymphatic fistula
5. Facial palsy (30 to 50% - often complete)
6. May involve carotid canal or jugular foramen (Carotid artery or jugular vein injury)

Question 8

Compared with otic-sparing fractures, patients with otic capsule-violating fractures are more severe.

Why?

Answer 8

They are:
2 to 5 times more likely to develop facial injury.
4 to 8 times more likely to develop CSF leak
7 to 25 times more likely to experience hearing loss
More likely to sustain intracranial injuries (epidural hematoma and subarachnoid hemorrhage)

Question 9

Modality of choice for the evaluation of facial trauma

Answer 9

MDCT

• Supplanted plain film radiography

Question 10

What are the four views usually used in plain film evaluation of acute facial trauma?

Answer 10

1. Caldwell view
2. Shallow Waters view
3. Cross-table lateral view
   4 Submental vertex view

Question 11

What are the uses of MR in facial injury? (3)

Answer 11

1. Injury of the orbital contents (optic nerve, globe, extraocular muscles)
2. Vascular complications (arterial dissection, pseudoaneurysm, and arteriovenous fistulas
3. Best way to evaluate trauma to the temporomandibular joint

Question 12

When is angiography indicated in facial trauma?

Answer 12

When clinical or radiographic evidence suggest a vascular injury

Question 13

Orbital emphysema is commonly caused by fracture of what bone?

Answer 13

Fracture of the thin medial orbital wall

Question 14

The most common fracture of the facial skeleton.

Answer 14

Nasal bone fracture

Question 15

Potential serious injury in nasal fracture that can cause cartilage necrosis (by disrupting the blood supply)

Answer 15

Septal hematoma