Imaging Case of the Week 141

The following facial x-ray (OM view) is from a 25 year old who has been punched in the face and has presented with pain, swelling and bruising around the left eye. What can be seen?


Facial X-Ray

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The OM (occipitomental) view shows left orbital emphysema, also called ‘the black eyebrow sign’. The medial aspect of the left orbital roof appears irregular.

Facial X-Ray orbital emphysema

CT of the facial bones showed a depressed fracture of the superomedial aspect of the left orbital roof communicating with the left frontal sinus, causing left orbital emphysema.

Left orbital roof fractureLeft orbital emphysemaThe patient was referred to a maxillofacial surgeon and underwent surgery.

Facial x-rays can be difficult to interpret. To make the interpretation a little bit easier, the affected side should be compared to the normal side. Also, tracing the McGrigor’s lines help. Details on the McGrigor’s line scan be found here.