Presentation
Fell on head.
Patient Data
Right orbital roof fracture involving the floor of the anterior cranial fossa, reaching the anterior clinoid process and sphenoid sinus, and with associated extraconal orbital emphysema and mild stranding within the right orbit. Right proptosis but without retrobulbar mass or collection.
Fracture passes obliquely through the sphenoid sinus, probably through the carotid canal (although it is not easy to discern) into the left petrous temporal bone fracture (longitudinal). No evidence of but without evidence of ossicular chain disruption or involvement of the otic capsule.
The fracture pattern is characteristic of a lateral frontal diagonal transsphenoidal base of skull fracture.
Case Discussion
Fractures of the base of skull that pass through the sphenoid sinus usually have a predictable pattern of extension which helps to identify subtle fractures.
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