Imaging Case of the Week 32

It is 1 am on a Saturday night. You are about to see a 30 year old man who has been assaulted at a pub. The left side of the patient’s face is swollen and the facial x-rays are as follows. What can you see?

OM view

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OM 30 view

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The OM (occipitomental) view shows:

  • irregularity over the centre of the left orbital floor
  • slight widening of the left frontozygomatic suture
  • fracture of lateral orbital wall
  • maybe fluid (blood in the context of trauma) in the left maxillary antrum

The OM (30) view shows:

  • left zygomatic arch fracture
  • there is also step deformity (inwards) of the lateral wall of the maxillary antrum

This patient has a combination of injuries called the Tripod Fracture which essentially consists of ipsilateral triad of:

  • zygoma fracture (break through the orbital floor and lateral wall of antrum)
  • zygomatic arch fracture
  • widening of frontozygomatic suture
Tripod fracture 1

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Tripod fracture 2

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Here are the CT images showing the left infraorbital fracture and fluid in the left maxiallry antrum clearly:

CT Facial bones 1

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CT Facial bones 2

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This patient needs referral to maxillofacial surgeons from the ED.

Thanks to Dr. Michael Lovegrove for the images.