Presentation
Fall. Exclude facial fracture.
Patient Data
Undisplaced fracture of the left supraorbital ridge.
1 wk later: Fall 1/52 prior/. Unwitnessed. Significant facial bruising & epistaxis. Since fall increasing confusion lethargy & reduced oral intake.
Acute hemorrhagic contusions in the left anterior frontal and bilateral orbitofrontal regions with surrounding edema and localized mass effect.
Mild background cerebral ischemia and atrophy.
Minimally displaced fracture of the left frontal bone extending into the left frontal sinus and supraorbital ridge. The fracture extends into the left lateral orbital wall with a bone fragment in close proximity to the left lateral rectus muscle.
Fractures of the anterior and lateral walls of the left maxillary antra are incompletely imaged. Small volume hemorrhage within the left ethmoid air cells.
Case Discussion
Most centers do less and less plain radiography in trauma, especially of the face. With this comes potential deskilling or anxiety in interpretation.
This case also illustrates 'film edge' awareness. Look at the periphery of the films and both views as this fracture is far easier to observe on the OM 30 rather than the frontal view.
As was identified a week later on CT, the facial fracture was one of the lesser worries to the patient from his unwitnessed fall.