全国消化道恶性病变介入诊疗研.ppt

FacialTrauma,JoniSkipper,MS-IVUSCSchoolofMedicine,Diagnosis?,Thischildpresentedwithdiplopiafollowingblunttraumatotherighteye.Onexam,hewasunabletomovehisrighteyeballuponupwardgaze.,BlowoutFractureoftheOrbit,Fracturesoftheorbitalfloormayoccurwithorbitalwallfracturesorasanisolatedinjury.Theisolatedinjuryisusuallycausedbyapplicationofpressuretotheglobeoftheeyebyobjectswitharadiusofcurvatureof5cmorless.Whentheorbitalfloor,beingtheweakestarea,givesway,herniationoforbitalcontentsdownintothemaxillarysinusmayoccur(hangingdropsign).Patientsmaypresentwithenophthalmos,impairedocularmotility,diplopiaduetoentrapmentoftheinferiorrectusmusclewithinthefracturefragments,andinfraorbitalhypoesthesia.,CT:BlowoutFractureofOrbit,A:Orbitalblowoutfracturewithdisplacementofthefloor(arrow),distortionoftheinferiorrectus,andherniationoforbitalfatthroughdefect.Arrowheadindicatesmedialfracture.B:Noteopacifiedleftanteriorethmoidaircellsanddisplacedmedialorbitalfracture(arrowheads).,ApproachtothePatientwithTraumaticInjuryoftheFace,Facialtraumaisdefinedasinjurytothesofttissuesoftheface(includingtheears)andtothefacialbonystructures.Mayresultinhemorrhageandairwayobstructionaccompaniedbymultisysteminvolvement(asmanyas60%ofpatientshaveassociatedinjuries)Evaluationincludeshistory,physicalexam,anddiagnosticimaging,HistoryofTraumaticEvent,Whatwasthemechanismofinjury?Wasthepatientmobile,restrained,orstationary?Istheinjurytheresultofbluntorpenetratingtrauma?,Wastheobjectthatcausedtheinjurymobileorstationary?Canthedegreeofenergytransferbeestimated?Arethereanyassociatedthermalorchemicalinjuriespresent?,AdditionalHistory,Whereisthelocationofanyfacialpainornumbness?Aretherevisionproblems,suchasdiplopia,present?,Doesmovementofthemandibleproducepain?Isthereanabnormal“bite”present?,TheExternalBonyFacialSkeleton,Composedmainlyofthefrontalbone,temporalbones,nasalbone,zygomas,maxilla,andmandible.Ethmoid,lacrimal,sphenoidbonescontributetoinnerportionoforbitsUpperthird-abovesuperiororbitalrimMiddlethird(midface)-superiororbitalrimdownthroughmaxillaryteethLowerthird-mandible,BonesoftheFacialSkeleton,PhysicalExamination,First,inspectfacefordeformityandasymmetryEnophthalmos,proptosis,ocularintegrity,ocularmovementsNasalseptumforposition,integrity,andpresenceofseptalhematomaEpistaxisorCSFrhinorrhea,PhysicalExamination,CompleteneurologicalexammustbeperformedonanypatientwithsuspectedfacialtraumaSensation-testall3majorbranchesofthetrigeminalnerveMotorfunction-assessfacialnervebyhavingpatientwrinkleforehead,smile,bareteeth,andcloseeyestightly,PhysicalExamination,Palpationoffacialstructures-theinfraorbitalandsupraorbitalridges,zygoma,nasalbones,lowermaxilla,andmandibleAssessfortenderness,bonydeformities,crepitus,andfalsemotionMalocclusionorstep-offindentitionmaybesignofmandibularfracture,DiagnosticImaging,Shouldfocusonbonyintegrity,fluid-filledsinuses,herniationoforbitalcontents,andsubcutaneousairOverallstatusofthepatient,physicalexamfindings,andthecliniciansinitialimpressiondeterminetimingandnatureofimagingordered,Plainfilms,TraditionallythemainstayintheradiographicevaluationoffacialtraumaStandardplainfilmfacialseries:Waters(occipitomental),Caldwell(occipitofrontal),andlateralviewsPanoramicfilmsareusedtobestevaluatemandibularfractures,CT,Offersaviable,cost-effectivealternativetoplainfilmsVeryhelpfulintheevaluationoffacialtraumawhenfacialedema,lacerations,otherinjuries,oralteredlevelofconsciousnesslimitusefulnessofclinicalexamConsiderinstitutionalwaitandturnaroundtime,MR,LimitedroleofMRinevaluationoffacialtraumaduetoinsensitivityofMRtofracturesUsedtoprovidecomplimentaryinformationtoCTintheevaluationoftheeyeanditsassociatedstructures,ForceofGravityImpactRequiredforFacialFracture,NasalFractures,MostcommonsiteoffacialtraumaduetolocationMaybedisplacedlaterallyorposteriorlyRequirescontrolofepistaxisanddrainageofseptalhematoma,ifpresent,ZygomaticFractures,Tripodfracture:zygomaticofrontalsuture,zygomaticotemporalsuture,andinfraorbitalforamenPresentwithflatnessofthecheek,anesthesiainthedistributionoftheinfraorbitalnerve,diplopia,orpalpablestepdefect,MaxillaryFractures,LeFortImaxillaLeFortIImaxilla,nasalbones,andmedialaspectsoforbits(pyramidaldisjunction)LeFortIIImaxilla,zygoma,nasalbones,ethmoids,vomer,andalllesserbonesofthecranialbase(craniofacialdisjunction)Usuallyincombination,MandibularFractures,Anypatientwithmalocclusionafterfacialtraum