1、屆全國消化道惡性病變介入診療研Joni Skipper, MS-IVUSC School of Medicine屆全國消化道惡性病變介入診療研l(wèi)This child presented with diplopia following blunt trauma to the right eye. On exam, he was unable to move his right eyeball up on upward gaze.屆全國消化道惡性病變介入診療研l(wèi)Fractures of the orbital floor may occur with orbital wall fractures

2、or as an isolated injury. The isolated injury is usually caused by application of pressure to the globe of the eye by objects with a radius of curvature of 5 cm or less. When the orbital floor, being the weakest area, gives way, herniation of orbital contents down into the maxillary sinus may occur

3、(hanging drop sign).lPatients may present with enophthalmos, impaired ocular motility, diplopia due to entrapment of the inferior rectus muscle within the fracture fragments, and infraorbital hypoesthesia. 屆全國消化道惡性病變介入診療研l(wèi)A: Orbital blowout fracture with displacement of the floor (arrow), distortion

4、 of the inferior rectus, and herniation of orbital fat through defect. Arrowhead indicates medial fracture.lB: Note opacified left anterior ethmoid air cells and displaced medial orbital fracture (arrowheads).屆全國消化道惡性病變介入診療研Facial trauma is defined as injury to the soft tissues of the face (includin

5、g the ears) and to the facial bony structures.May result in hemorrhage and airway obstruction accompanied by multisystem involvement (as many as 60% of patients have associated injuries)Evaluation includes history, physical exam, and diagnostic imaging 屆全國消化道惡性病變介入診療研l(wèi)What was the mechanism of injur

6、y?lWas the patient mobile, restrained, or stationary?lIs the injury the result of blunt or penetrating trauma?lWas the object that caused the injury mobile or stationary?lCan the degree of energy transfer be estimated?lAre there any associated thermal or chemical injuries present?屆全國消化道惡性病變介入診療研l(wèi)Whe

7、re is the location of any facial pain or numbness?lAre there vision problems, such as diplopia, present?lDoes movement of the mandible produce pain?lIs there an abnormal “bite” present?屆全國消化道惡性病變介入診療研l(wèi)Composed mainly of the frontal bone, temporal bones, nasal bone, zygomas, maxilla, and mandible.lEt

8、hmoid, lacrimal, sphenoid bones contribute to inner portion of orbitslUpper third - above superior orbital rimlMiddle third (midface)- superior orbital rim down through maxillary teethlLower third - mandible屆全國消化道惡性病變介入診療研屆全國消化道惡性病變介入診療研l(wèi)First, inspect face for deformity and asymmetrylEnophthalmos,

9、proptosis, ocular integrity, ocular movementslNasal septum for position, integrity, and presence of septal hematomalEpistaxis or CSF rhinorrhea 屆全國消化道惡性病變介入診療研l(wèi)Complete neurological exam must be performed on any patient with suspected facial traumalSensation - test all 3 major branches of the trigem

10、inal nervelMotor function - assess facial nerve by having patient wrinkle forehead, smile, bare teeth, and close eyes tightly屆全國消化道惡性病變介入診療研l(wèi)Palpation of facial structures - the infraorbital and supraorbital ridges, zygoma, nasal bones, lower maxilla, and mandiblel Assess for tenderness, bony deform

11、ities, crepitus, and false motionlMalocclusion or step-off in dentition may be sign of mandibular fracture屆全國消化道惡性病變介入診療研l(wèi)Should focus on bony integrity, fluid-filled sinuses, herniation of orbital contents, and subcutaneous airlOverall status of the patient, physical exam findings, and the clinicia

12、ns initial impression determine timing and nature of imaging ordered屆全國消化道惡性病變介入診療研l(wèi)Traditionally the mainstay in the radiographic evaluation of facial traumalStandard plain film facial series: Waters (occipitomental), Caldwell (occipitofrontal), and lateral viewslPanoramic films are used to best ev

13、aluate mandibular fractures屆全國消化道惡性病變介入診療研l(wèi)Offers a viable, cost-effective alternative to plain filmslVery helpful in the evaluation of facial trauma when facial edema, lacerations, other injuries, or altered level of consciousness limit usefulness of clinical examlConsider institutional wait and tu

14、rnaround time屆全國消化道惡性病變介入診療研l(wèi)Limited role of MR in evaluation of facial trauma due to insensitivity of MR to fractureslUsed to provide complimentary information to CT in the evaluation of the eye and its associated structures屆全國消化道惡性病變介入診療研BoneForce of gravity (g)Nasal bones30Zygoma50Angle of mandib

15、le70Frontal-glabellar region80Midline maxilla100Midline mandible (symphysis)100Supraorbital rim200屆全國消化道惡性病變介入診療研l(wèi)Most common site of facial trauma due to locationlMay be displaced laterally or posteriorlylRequires control of epistaxis and drainage of septal hematoma, if present屆全國消化道惡性病變介入診療研l(wèi)Tripo

16、d fracture: zygomaticofrontal suture, zygomaticotemporal suture, and infraorbital foramenlPresent with flatness of the cheek, anesthesia in the distribution of the infraorbital nerve, diplopia, or palpable step defect屆全國消化道惡性病變介入診療研l(wèi)Le Fort I maxillalLe Fort II maxilla, nasal bones, and medial aspects of orbits (pyramidal disjunction)lLe Fort III maxilla, zygoma, nasal bones, ethmoids, vomer, and all lesser bones of the cranial base (craniofacial disjunction)lUsually in combination屆全國消化道惡性病變介入診療研l(wèi)Any patient with malocclusion a