屆全國消化道惡性病變介入診療研課件

1、屆全國消化道惡性病變介入診療研1 Joni Skipper, MS-IV USC School of Medicine 屆全國消化道惡性病變介入診療研2 lThis 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3 lFractures of the orbital floor may occur with orbital wall f

2、ractures 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 m

3、ay occur (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4 lA: Orbital blowout fracture with displacement of the floor (arrow)

4、, distortion 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5 Facial trauma is defined as injury to the soft tissues of th

5、e face (including 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6 lWhat was th

6、e mechanism of injury? 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 pr

7、esent? 屆全國消化道惡性病變介入診療研7 lWhere 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8 lComposed mainly of the frontal bone, temporal bones, nasal bone,

8、zygomas, maxilla, and mandible. lEthmoid, lacrimal, sphenoid bones contribute to inner portion of orbits lUpper third - above superior orbital rim lMiddle third (midface)- superior orbital rim down through maxillary teeth lLower third - mandible 屆全國消化道惡性病變介入診療研9 屆全國消化道惡性病變介入診療研10 lFirst, inspect fac

9、e for deformity and asymmetry lEnophthalmos, proptosis, ocular integrity, ocular movements lNasal septum for position, integrity, and presence of septal hematoma lEpistaxis or CSF rhinorrhea 屆全國消化道惡性病變介入診療研11 lComplete neurological exam must be performed on any patient with suspected facial trauma l

10、Sensation - test all 3 major branches of the trigeminal nerve lMotor 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12 lPalpation of facial structures - the infraorbital and supraorbital ridges, zygoma, nasal bones, lower m

11、axilla, and mandible l Assess for tenderness, bony deformities, crepitus, and false motion lMalocclusion 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13 lShould focus on bony integrity, fluid-filled sinuses, herniation of orbital contents, and subcutaneous air lOverall

12、status of the patient, physical exam findings, and the clinicians initial impression determine timing and nature of imaging ordered 屆全國消化道惡性病變介入診療研14 lTraditionally the mainstay in the radiographic evaluation of facial trauma lStandard plain film facial series: Waters (occipitomental), Caldwell (occ

13、ipitofrontal), and lateral views lPanoramic films are used to best evaluate mandibular fractures 屆全國消化道惡性病變介入診療研15 lOffers a viable, cost-effective alternative to plain films lVery helpful in the evaluation of facial trauma when facial edema, lacerations, other injuries, or altered level of consciou

14、sness limit usefulness of clinical exam lConsider institutional wait and turnaround time 屆全國消化道惡性病變介入診療研16 lLimited role of MR in evaluation of facial trauma due to insensitivity of MR to fractures lUsed to provide complimentary information to CT in the evaluation of the eye and its associated struc

15、tures 屆全國消化道惡性病變介入診療研17 BoneForce of gravity (g) Nasal bones30 Zygoma50 Angle of mandible70 Frontal-glabellar region80 Midline maxilla100 Midline mandible (symphysis)100 Supraorbital rim200 屆全國消化道惡性病變介入診療研18 lMost common site of facial trauma due to location lMay be displaced laterally or posteriorl

16、y lRequires 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19 lTripod fracture: zygomaticofrontal suture, zygomaticotemporal suture, and infraorbital foramen lPresent with flatness of the cheek, anesthesia in the distribution of the infraorbital nerve, diplopia, or p

17、alpable step defect 屆全國消化道惡性病變介入診療研20 lLe Fort I maxilla lLe 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21 lAny patient with malocclusion a