Case 5 - Cominuted Nasal Bone Fracture

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication:

90-year-old, found down on the street. Lightheadedness status post fall.

TECHNIQUE: Axial CT scan images were performed through the facial bones, brain, cervical spine, thoracic spine, and lumbar spine despite the fact that the clinical evaluation states no bony tenderness, deformity, or step-offs in the cervical, thoracic, or lumbar spine.

FINDINGS:

Brain:

There is no evidence of intracranial hemorrhage. No mass effect is seen. The ventricles and sulci are normal. There are no extra-axial hemorrhagic collections.

There is periventricular and subcortical white matter hypodensity bilaterally. This is age-appropriate.

Maxillofacial region

There is extensive soft tissue swelling overlying the orbits, left greater than right. The left forehead also shows soft tissue swelling. There is blood layering in the maxillary antra as well as in the sphenoid sinus bilaterally.

Facial bone fractures are present with bilateral nasal bone fractures. The left lateral orbit shows a fracture. The anterior wall of the right maxillary antrum is fractured as are the pterygoid plates bilaterally. The medial orbital wall is fractured on the left side. There is fracture extending from the nasal ethmoidal junction into the frontal sinus bilaterally.

The left orbital floor, at the infraorbital foramen appears to show fracture as well. The medial maxillary wall extending to the right nasal cavity is fractured on the right side. The orbital floor is fractured also on the right side seen best on coronal reconstructions along the medial aspect, medial to the infraorbital foramen with involvement of the medial orbital wall. This is best seen on series 4 image 241.

There are areas of the cribriform plate which appear to be dehiscent.

The mastoid air cells and middle ear cavities are clear.

Orbital emphysema on the left side is present likely from the orbital floor fracture.

Cervical spine:

The alignment of the vertebral bodies is anatomic. There are anterior osteophytes at C3-4, C4-5, C5-6, and C6-7. Small posterior osteophytes are also present at C5-6 and C3-4.

Axial scans through the cervical spine show degenerative changes most notably at the C3-4 level with uncovertebral joint degenerative change and facet degenerative change resulting in moderate to severe left greater than right foraminal narrowing. The same is true at the C4-5 level with left greater than right foraminal narrowing. At the C5-6 level of the foraminal narrowing is symmetrical largely from the uncovertebral joint degenerative change. There is left-sided foraminal narrowing at the C6-7 level.

No neck masses are present.

There are no acute fractures identified.

Thoracolumbar spine:

The alignment of the vertebral bodies is normal. Mild degenerative changes are noted at the L1-2 and L2-3 level with disc space narrowing. No compression deformities are present.

Degenerative facet joint disease is present at L5-S1 and L4-5.

The esophagus is dilated and there appears to be a hiatal hernia.

No fractures are seen in the thoracic and lumbar spine.

IMPRESSION:

Extensive facial bone fractures with bilateral pterygoid plate fractures and what appears to be a LeFort III type fracture on the left side going through the lateral orbital wall and medial orbital wall with extension to the cribriform plate region and the left sphenoid sinus as well as the left nasal ethmoidal strut extending into the frontal sinus. On the right side there is evidence of LeFort I and II type fracture as well as inferomedial orbital floor fracture. The anterior wall of the right maxillary sinuses comminuted and there is emphysematous changes in the adjacent soft tissues of the face. The orbital rim on the right is also fractured. Sphenoid sinus fractures are present on the left side.

Unremarkable evaluation of the brain, cervical spine, thoracic spine, and lumbar spine.