Facial and Temporal Bone Trauma Diagnostic imaging and therapeutic challenges in emergency
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1 Facial and Temporal Bone Trauma Diagnostic imaging and therapeutic challenges in emergency ATTYE A, KRAINIK A Department of Neuroradiology and MRI University Hospital Grenoble / University Grenoble Alpes UMS IRMaGe / Grenoble Institut of Neurosciences
2 Learning objectives To know normal Facial and T-Bone radioanatomy To know facial lesions classification in trauma To know orbital and cranial nerves complications To know how to describe primary lesions in T-Bone trauma To know pros and cons of imaging modalities in patients with post-traumatic deafness
3 From Winegar, Radiographics 2013 System of facial buttresses and potential complications of fractures
4 Accurate description of facial fractures and complications is of importance for surgical planning Side fracture - Orbital fractures - Mandible fractures Midface fractures Anterior fractures Le Fort fractures
5 Midface fractures Anterior fractures Nasal bone fractures NOE: Naso-OrbitoEthmoid complex NOE + Frontal bone NOE + Frontal bone + Zygoma
6 Nasal bones fracture Normal radioanatomy Anterior fracture
7 Nasal bones fracture Posterior fracture
8 NOE pattern: Nasal bones + medial orbital wall fracture
9 NOE pattern: could involve the lacrymal duct
10 NOE pattern + Frontal bones
11 NOE pattern + Frontal bones + Maxillary sinus
12 NOE pattern + Frontal bones + Maxillary sinus: risk of dural tear - May lead to frontal sinus cranialization - Risks of delayed brain infection
13 NOE pattern + Frontal bones + Maxillary sinus: risk of dural tear
14 NOE pattern + Frontal bones + Maxillary sinus: risk of dural tear Day 1 Day 7
15 NOE pattern + Frontal bones + Maxillary sinus: risk of olfactory bulbs injuries Healthy Post-trauma anosmia
16 Midface fractures Le Fort fractures Type 3 Type 2 Type 1
17 Le Fort Fractures: Surgical procedure if abnormal occlusion between the maxillary and mandibular teeth
18 Le Fort Fractures: All Le Fort fractures include a fracture through the pterygoid plates Keypoint: Pterygoid plates analysis
19 Le Fort Fractures: All Le Fort fractures include a fracture through the pterygoid plates Le Fort 3 Orbital lateral wall
20 Le Fort Fractures: All Le Fort fractures include a fracture through the pterygoid plates Le Fort 2 Orbital lateral floor
21 Le Fort Fractures: All Le Fort fractures include a fracture through the pterygoid plates Le Fort 1 Inferior margin of the piriform aperture
22 Le Fort Fractures: Beware of hemi Le Fort Intermaxillary disjunction
23 Side fractures zygomaticomaxillary complex fractures/orbital fractures Mandible fractures
24 Orbital fractures: Beware of air bubbles Cornea laceration Eye prothesis Vitrectomy with gas Air under the eyelid
25 Orbital fractures: Beware of metal Choroid hematoma Metal foreign body Wooden foreign body
26 Orbital fractures: oculomotricity trouble Entrapment of the left inferior rectus muscle
27 Orbital fractures: oculomotricity trouble Entrapment of the left inferior rectus muscle Key point: Orbital floor
28 Orbital fractures: oculomotricity trouble Entrapment of the right medial rectus muscle
29 Orbital fractures: optic canal Traumatic optic neuropathy is a devastating potential complication of closed head injury, even with immediate decompression surgery Welkoborsky, HNO 2011
30 Orbital fractures: optic canal
31 Orbital fractures: post-traumatic blindness
32 Orbital fractures: orbital roof fractures
33 Orbital fractures: orbital roof fractures
34 Side fractures zygomaticomaxillary complex fractures/orbital fractures Mandible fractures
35 Mandible fractures Mandible fracture Trismus
36 Mandible fractures: differential diagnose Malar fracture
37 Mandible fractures: Surgery in cases with fractures involving the dental part «Ring-like» configuration
38 Mandible fractures: Surgery required Dental part involvement
39 Mandible fractures: No surgical management Joint fracture Transcortical fractures
40 Mandible fractures: Associated dental fracture
41 Mandible fractures: Associated dental fracture Keypoint: Dental root avulsion
42 Temporal bone trauma Accurate description of ossicular luxation and facial nerve involvement is of importance for surgical planning T bone or brain trauma with SNHL - 3D-FLAIR non enhanced imaging - Parenchyma exploration T bone fracture with CHL Ossicular analysis After hemotympanum resorption
43 Temporal bone trauma Maillot et al, Insight into imaging
44 Temporal bone trauma Maillot et al, Insight into imaging
45 Temporal bone trauma IM joint IS joint
46 Temporal bone trauma T-bone fractures: Associated conductive hearing loss Normal radioanatomy IM joint luxation Maillot et al, Journal of Neuroradiology
47 Temporal bone trauma T-bone fractures: Associated conductive hearing loss Key point: ossicular chain analysis Maillot et al, Journal of Neuroradiology IS joint luxation
48 Temporal bone trauma T-bone fractures: Associated sensorineural hearing loss Pneumolabyrinth
49 Temporal bone trauma T-bone fractures: Associated sensorineural hearing loss Schuknecht 3rd Edition Intralabyrinthin hemmorhage 3D-FLAIR imaging
50 Temporal bone trauma T-bone fractures: Associated sensorineural hearing loss Intralabyrinthin hemmorhage
51 Temporal bone trauma FA decrease in post traumatic vestibulopathy Alhilali et al, Radiology 2014
52 Temporal bone trauma T-bone fractures: Associated facial palsy VII1n course fracture
53 Temporal bone trauma T bone fractures: Associated facial palsy VII2n course fracture
54 Temporal bone trauma T-bone fractures: Associated abducens nerve palsy Petrous apex fracture
55 Temporal bone trauma T-bone fractures: Associated abducens nerve palsy
56 Take home message CT: primary screening MRI if CT unclear Mechanism of facial trauma Don t forget Pterygoid plates Optic canal Orbital roof Ossicular chain Inner ear analysis
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