Superselective embolization for severe traumatic epistaxis caused by fracture of the skull base

Intractable epistaxis developed in a 13-year-old girl after she fell down a flight of stairs sustaining facial fractures and fracture of the skull base. Epistaxis was found to emanate from a right ascending pharyngeal artery, which the authors promptly and successfully embolized using polyvinyl alcohol particles and microfibrillar collagen.

Posterior dislocation of mandibular condyle into external auditory canal. A case report

A case is reported of a 49-year-old edentulous patient who suffered a posterior dislocation of the right fractured mandibular condyle causing a fracture of the tympanic plate. This was associated with a right transverse fracture of the petrous bone and an intact tympanic membrane. Some of the problems related to this condition are discussed.

Postoperative computed tomography study of pterygomaxillary separation during the Le Fort I osteotomy

Computed tomography (CT) was used postoperatively to assess the pterygomaxillary region in 12 orthognathic surgery patients who had had a Le Fort I osteotomy. Although pterygomaxillary separation was successful in all cases, in only 41.6% of the sides did fractures of the plate not occur. The incidence of low pterygoid plate fracture was 37.5% and that of high pterygoid plate fracture was 25%; 4.2% of sides showed a maxillary tuberosity fracture. Multiple fractures were observed in 8.3% of separated plates. Of 17 pterygoid plates judged clinically to be intact, only 10 were intact as assessed by CT. The significance of these findings and application of CT to evaluation of modifications to the Le Fort I osteotomy is discussed.

Altering the angulation of a curved osteotome--does it have effects on the type of pterygomaxillary disjunction in Le Fort I osteotomy? An experimental study

A standard Le Fort I osteotomy was performed on 12 cadavers to determine whether the incidence of pterygoid plate fractures could be reduced by increasing the angle of the curved osteotome relative to the sagittal plane. In the group where an osteotome with the usual angulation was employed, fractures occurred on 9 of 12 sides. In the increased angulation group, 5 of 12 pterygoid plates were fractured. All fractures were restricted to the level of the horizontal osteotomy cut. It is concluded that increased angulation of a curved osteotome can decrease the incidence of fractures of the pterygoid plates. This procedure, however, is not recommended because it can cause fracture of the palatine bone or displacement of the fractured pterygoid plate fragment posteriorly.

Air in the temporomandibular joint fossa: CT sign of temporal bone fracture

Temporal bone fractures can be difficult to detect clinically and radiographically. Air is sometimes present in the glenoid fossa of the temporomandibular joint (TMJ) at computed tomography (CT) of acute basilar skull fractures. This study evaluated TMJ fossa air as a sign of temporal bone fracture. Initial CT scans of the head in 114 patients with a diagnosis of basilar skull fracture at discharge were retrospectively reviewed. TMJ fossa air was present in 23 of 114 patients (20.2%) and was bilateral in three patients. Only temporal bone fractures were significantly (P less than .001) associated with TMJ fossa air. Temporal bone fractures were observed at CT in 23 of 26 cases of TMJ fossa air, but in three of 26 cases, TMJ fossa air was the only CT sign of clinically apparent temporal bone fractures. TMJ fossa air is associated with acute temporal bone fracture and may be the only CT sign of an otherwise inconspicuous temporal bone fracture.

Pterygoid plate separation using an oscillating saw in Le Fort I osteotomy. Technical note

An oscillating saw is used to achieve pterygomaxillary separation. The procedure is quick and simple to perform and avoids the potentially hazardous use of osteotomes for this purpose. Down fracture of the maxilla allows visual confirmation of the integrity of the pterygoid plates.

Blunt trauma leading to facial nerve paralysis

A case in a young child of blunt trauma to the facial nerve, distal to the stylomastoid foramen, is reported. Although the patient made an uneventful recovery, an understanding of the possible sites of injury of the facial nerve and further investigations available to aid diagnosis is important. This child was followed up in the Accident and Emergency Department, however, early referral of this rare condition to an otolaryngologist is advisable.

Optic nerve blindness following a malar fracture

Optic nerve blindness following a malar fracture is an uncommon and usually permanent complication. When the loss of vision is immediate and total, the prognosis is poor. The case of a patient who suffered immediate and complete loss of vision after a malar fracture is presented. Computed tomography revealed compression of the optic nerve by bony fragments. No improvement was observed after megadose steroids and surgical treatment. The incidence, pathogenesis, diagnostic approach and therapeutic possibilities are discussed and the importance of establishing precisely the moment of the loss of vision is stressed.

Bowel visualization during indium-111-labelled diethylene triamine penta-acetic acid cisternography due to massive cerebrospinal fluid leak. Case report and review of the literature

We report a case of massive cerebrospinal fluid (CSF) leakage where the tracer injected intra-thecally for radionuclide cisternography was later visualized in the bowel as well as the nasopharynx. We discuss the potential implications of this finding in patients with CSF leaks. A brief review of the diagnosis of CSF leaks is included.

Sphenoid fractures: prevalence, sites, and significance

The computed tomographic (CT) scans of the head of 490 blunt trauma victims were reviewed to establish the frequency of sphenoid fractures. There were 111 patients with craniofacial fractures, 78 of whom had fractures of the sphenoid bone. In 51 of the 78 patients these were associated with complex facial fractures, and in the 27 remaining patients they represented primarily fractures of the skull base. The number of sphenoid fractures not only exceeded those that involved the other bones of the base of the skull, including the temporal bone, but also exceeded the number of fractures of the cranial vault that could be identified with CT. All available charts were reviewed for the patients with sphenoid fractures in order to determine the presence of potentially related injuries. In 21 patients there were complications that included damage to the internal carotid artery, cerebrospinal fluid rhinorrhea, optic nerve damage, superior orbital fissure syndrome, and posttraumatic diabetes insipidus.

Contrecoup fractures of the anterior cranial fossae as a consequence of blunt force caused by a fall

Contrecoup fractures of the base of the skull are regarded as rare in the clinical literature. In our material (n = 171 falls on the same level and on or from stairs), the overall frequency of contrecoup fractures of the anterior cranial fossa in fatal cranio-cerebral trauma due to falls was 12%, as compared to 24% with occipital point of impact of the head. The relationships between the impact site on the head, form of fracture at the point of impact with involvement of the skull cap and/or the base of the skull, coup and contrecoup injuries of the brain, localization of contrecoup fractures in the anterior cranial fossa and the occurrence of monocle and spectacle haematomas display a major variability. Fractures occur in the form of simple fractures and as impression fractures (fracture fragments or fracture boundaries displaced to the inside). Clinical diagnosis is difficult because of the concealed position of the anterior skull base. Contrecoup fractures become of forensic medical significance when symptoms of a frontobasal injury occur for the first time after trauma which has occurred some time in the past and when the question arises as to the causal connection with the original trauma. In investigation of living persons, it may be difficult to decide whether haemorrhages in the region of the orbit and its vicinity result from a direct blunt force or derive from fractures of the base of the skull, especially contrecoup fractures.

[Computed tomographic assessment of orbital fractures in traumatic damage of the optic nerve]

Ten patients with orbital fractures and optic nerve trauma are reported. Fractures of the optic canal could be demonstrated by computed tomography in six cases and fractures of the orbital apex in another three cases. Surgical decompression of the optic canal was performed in seven cases. Computed tomography enhanced decision for surgery in cases of intraorbital haematoma with exophthalmus and narrowing of the canal by bony fragments, especially in those patients presenting with incomplete or progressive visual disturbance.

[Skullbase-penetrating injuries caused by umbrella tips: case reports]

Two cases of skullbase-penetrating injuries caused by umbrella tips are reported. Case 1: 24-year-old male. Admitted with disturbance of consciousness, left hemiparesis, nasal bleeding, and laceration of left lower eyelid because of having been stabbed by an umbrella tip. Pupils and fundi revealed no definite findings. Plain skull X-ray showed turbid ethmoid sinus and fracture of planum sphenoidale. Cranial CT showed right putaminal hematoma with intraventricular hemorrhage and pneumocephalus. Increased ICP necessitated surgery two days after the injury. Dural laceration of planum sphnoidale, laceration of left optic nerve, right rectal gyrus contusion and rebleeding from the right lenticulostriate branch were observed. Dural plasty and removal of hematoma with external decompression were carried out. He had a good postoperative course, but left visual loss and left hemiparesis remained. Case 2: 29-year-old male. Admitted with excoriation of his right nostril because of having been stabbed by an umbrella tip, severe headache, and nasal discharge. Oculomotor palsy was observed as well as CSF rhinorrhea and meningeal irritability. Plain skull X-ray showed niveau in sphenoidal sinus, pneumocephalus, and fracture of sella turcica. His complaint disappeared after conservative therapy. We reviewed the literature and found only 4 similar cases. The skullbase, because of its anatomical character, is likely to be penetrated in orbital and periorbital injury caused by umbrella tips. Cases which include disturbance of consciousness have a poor prognosis. We hope the fact that umbrella tips can easily become life-threatening objects will come to the attention of the general public so that similar cases may be avoided.

Basilar skull fractures in children

In this paper we are reporting a retrospective study of patients under 18 years of age managed at the Los Angeles County/University of Southern California Medical Center from January 1979 through December 1987 with the diagnosis of basilar skull fracture. Sixty-two patients with basilar skull fractures were admitted during that 7 1/2 year period. The most common etiology was pedestrain versus vehicle accidents (42%), followed by falls (27%), vehicle accidents (23%), and being hit by an object (8%). The most common physical findings were hemotympanum (58%) and bleeding in the ear canals (47%). Thirty-four percent of the patients complained of hearing loss. Cerebrospinal fluid otorrhea was noted in 16 patients (26%), while only 1 patient had cerebrospinal fluid rhinorrhea. Facial nerve paralysis was present in 8 patients (13%). Vestibular symptoms were rare. Sixty-three percent of the patients had the diagnosis confirmed by radiography. The clinical presentation, complications, management and outcome of basilar skull fractures in the pediatric population are discussed.

Isolated basilar artery occlusion associated with a clivus fracture

Most vascular injuries to the brain secondary to blunt head trauma involve the internal carotid circulation. A case of isolated basilar occlusion secondary to a clival fracture is described and compared to three other cases in the literature.

Transient abducens nerve palsy following a Le Fort I maxillary osteotomy: report of a case

A case of transient abducens nerve palsy following Le Fort I maxillary osteotomy is reported. The results of the CT scan strongly suggest the cause was a fracture of the body of the sphenoid bone but the cause of the fracture is unclear. The palsy occurred on the first postoperative day and recovery took approximately 5 months. The most likely explanation for the complication is a transmittal of force from the osteotome used to fracture through the pterygoid plates extending superiorly through the medial surface of the cavernous sinus. This case clearly demonstrates the importance of care in positioning of the pterygomaxillary osteotome.

Traumatic injuries of the paranasal sinuses

High-resolution imaging, based on CT, has become the expected standard of imaging in severe sinofacial trauma. Imaging must include both bone and soft-tissue detail. Intracranial complications such as hematoma, contusion, and dural tear must be noted and followed appropriately. Early orbital assessment must be included to allow surgical decompression of hematoma or fracture reduction before irreversible changes to the visual pathway occur. Clinical assessment and initial, limited plain films offer an invaluable overview to set up priorities in resuscitation and subsequent direction for more detailed assessment by higher-resolution imaging. Complex facial fractures in noncontiguous structures are increasingly noted with high-velocity trauma. Open communication between clinician and radiologist should prevent only partial assessment of the true extent of involvement. Increasing use of CT (and possibly MRI in the near future) to follow persisting post-reduction complications (Fig. 14)--whether altered position of bone grafts or implants, ocular motility disorders and enophthalmos, or sinus obliteration or ablation--has resulted in the further need for the clinician and radiologist to understand each other's capabilities, in order to offer the patient maximum benefit from his or her imaging referral.

Fractures of the sphenoid bone

Fractures of the sphenoid bone occur following injury to the orbit and base of the skull. Such fractures are important since they can cause loss of vision and damage to various neural and muscular tissues. Ocular injury is also commonly associated. This paper reviews the hospital records of 112 consecutive patients with fractures of the base of the skull for the cause, frequency of signs and symptoms, and treatment of the sphenoid bone injury. Various deformities and dysfunctions are correlated with imaging data and classified to describe specific clinical syndromes. Several cases of sphenoid bone fracture serve as examples of diagnostic and treatment techniques.

Pterygoid plate fractures caused by the Le Fort I osteotomy

Le Fort I osteotomies have been carried out on eight cadavers to determine whether pterygomaxillary dysjunction with a curved chisel causes fractures of the pterygoid plates. Fractures occurred on 12 of the 16 sides, were either at the level of the osteotomy cut or near to the base of the skull, and were sometimes multiple. There was no apparent correlation between the presence, type or extent of pterygoid plate fracture and whether or not that side of the osteotomy was completed first.

[Neurosurgical aspects of frontobasal injuries with cerebrospinal fluid fistulas: experience with 205 operated patients]

Over a period of 15 years the author operated on 205 patients with traumatic frontobasal CSF fistulas. In one third of these cases, exploration had to take place within 24 hours because of cerebral compression or a direct open injury. Craniotomy enables the surgeon to repair the concomitant neurosurgical lesions frequently found (57%) as well as the often multiple (56%) or bilateral (35.3%) fistulas. As regards surgical technique, the important points are: protection of the brain thanks to the use of magnification, the best possible approach, lumbar puncture during surgery to relieve pressure, sufficient cerebral debridement and in the paranasal sinuses, reliable closure of the fistula (duraplasty and sometimes additional plastic closure of the bony defect), and consideration of the latest findings of neuroanaesthesia, endocrinology etc. Nearly two-thirds of the patients operated were able to resume work completely.

Blindness following fracture of the zygomatic bone

Two cases of blindness following fracture of a zygomatic bone, with disruption of the optic canal are reported. The importance of excluding optic canal disruption where blindness results subsequent to fracture or surgery to the orbit in the presence of certain features of retrobulbar haemorrhage is emphasised.

Clinical study of the pattern electroretinogram in patients with optic nerve damage

We have recorded both pattern and flash electroretinograms (ERG) in two patients with unilateral optic nerve damage due to optic canal fracture over one year. The pattern ERG from the affected eye was reduced in amplitude by approximately 40% in one patient, 60% in the other, compared with that from their other, normal eyes, while the flash ERG was normal in all eyes. Reduced pattern ERG responses may depend on retrograde degeneration following damage to the optic nerve. The pattern ERG, however, was not totally lost in the eyes with marked optic atrophy. There is a possibility that the pattern ERG contains both contrast and luminance components in various proportions.

[Occult fractures of the skull]

Fractures of the skull represent a problem in traumatologic X-ray-diagnosis. The higher rate of errors in the skull compared with the rest of the skeleton result from problems in differentiation of fracture-lines from vascular channels and impressions in overlying skeletal structures. By special examination of the suspected region (special X-ray-views, conventional tomography, CT, magnification views etc.) additional information can be obtained, e.g., exact demonstration of dislocated bone fragments or the detection of intracranial hematomas as well as the unmasking of the fracture lines and their dimensions. Very often these special procedures results are the basis for correct treatment. For various skull regions, where masked fractures often occur, recommended radiological pathways are presented in order to find these fractures and to obtain additional information.

CT demonstration of optic canal fractures

Traumatic blindness is a well recognized entity with a guarded prognosis. Previous studies have variously reported the incidence of concomitant optic canal fractures and response to surgical therapy. With the advent of CT scanning, a new technique for study of these severely injured patients has become available. Over a period of 20 months, optic foramen fractures were demonstrated in 10 such patients using finely collimated, high-resolution CT scans. Fractures were easily classified by location, relation to the optic nerve assessed, and associated facial injuries imaged. The technique is easy, rapid, and superior to polytomography in this setting. Possible implications for therapy are discussed.

Sphenotemporal buttress fracture

A new fracture type visible on CT images of the base of the skull is described. In this fracture the sphenoidal connection to the zygomatic and temporal bone breaks off all its three extensions. It was recognized in five patients with severe head injuries. In three surviving patients it was associated with ipsilateral persistent amaurosis. This fracture should alert the investigator to the possible sequelae of the head injury.

Penetrating injury of the tuberculum sellae

An unusual case of perforation of the tuberculum sellae and right ethmoid bone by a 10-in. serrated bread knife is described. The patient survived with no neurological or endocrine deficit. The importance of preoperative angiography and control of the proximal and distal vasculature is stressed.

[Epidemiology of fronto-basilar head injuries]

Fractures of the cranial basis in the anterior cranial fossa accounted in a ten-year period in the material of the authors for 2.6% of cranial traumas and 24.6% of cranial basis fractures. In the observed cases rhinorrhoea was present in only 16% of cases. Purulent meningitis as a complication was observed in only 1.8% of cases and only late after the trauma. In view of the low frequency of inflammatory complications evidencing a considerable tendency for spontaneous healing of fistulas the authors suggest restriction of indications to surgical treatment in early period after trauma to cases with visible wide fissure in the fractures bone, displacement of fractured fragments and their position at different levels.

Computed tomography and cerebrospinal fluid leak

Cerebrospinal fluid (CSF) rhinorrhea is a serious condition which if untreated may lead to meningitis. Detection of the leak site at surgery may be difficult without prior accurate radiological localization of the leak and at times repeat operation has been required. Clinical and radiological localization of the leak is not always easy and many different tests have been tried. Prior to computed tomography (CT), the most common combination of radiological tests were plain films and tomograms of the skull and CSF isotope studies. Although CT scanning may be helpful in assessing a patient with CSF rhinorrhea, it is most effective when combined with intrathecal Metrizamide. The combination of Metrizamide and CT was first reported in 1977 and several case reports and small series of cases have since been reported. The purpose of this article is to review the value of CT especially when used in combination with Metrizamide in the patient with CSF leak and also to discuss the technique of the combined study and to show its value with illustrative cases.

[Pneumatocephalus: a clinical contribution (author's transl)]

Treatment of traumatic brain oedema leads to a decrease in raised intracranial pressure, and this may facilitate formation or progression of pneumatocephalus. Lumbar puncture or lumbar CSF drainage for treatment of CSF-rhinorrhoea/otorrhoea is occasionally responsible for the occurrence or enhancement of pneumatocephalus. Pneumatocephalus with radiological absence of fracture of the skull and absence of CSF leakage signifies communication between rhinocranium and encephalocranium: this supplies evidence of an open head injury. Post-traumatic opacification of the sphenoid sinus and presence of suprasellar air, as well as traumatic lesion of the optic chiasma are pathognomonic for the presence of a fracture of the planum sphenoidale. Computerised axial tomography is superior to plain skull x-rays in the localisation of intracerebral air.

[The value of CT in the diagnosis of traumatic fronto-basal CSF fistulae (author's transl)]

In 20 patients with fronto-basal CSF fistulae, radiograms, tomograms and CTs in the axial and coronal projection were taken before operation. The evaluation showed that small fractures of the cribriform lamina could be demonstrated most clearly by CT with narrow coronal sections. Although the resolution properties of CT is still inferior to that of tomography for small osseous fissures, good CT results could be achieved by the better demonstration of accompanying mucosal swelling and/or small effusions. Fractures of the walls of the frontal sinuses, on the other hand, where shown better by tomography and those of the frontal calotte by normal radiograms.

Proptosis secondary to subdural hematoma

A subdural hematoma extending into the orbit through a fracture of the sphenoid bone appeared as unilateral proptosis with no neurologic abnormalities. Repeated percutaneous needle aspirations of the orbital portion of this mass provided only temporary relief of proptosis, but decompressed the intracranial portion of the hematoma adequately for prevention of neurologic manifestations. Ultrasonography correctly diagnosed the nature of the lesion and identified the bony dehiscence. Computed tomographic (CT) evaluation suggesting that a tumor might be present led to the performance of curative neurosurgery. Even when seemingly trivial, head trauma must be considered along with congenital, developmental, and neoplastic causes as a potential cause of intracranial cyst formation that can produce proptosis.

Computerized tomographic scan findings in facial fractures associated with blindness

A retrospective study of 379 consecutive patients who underwent operative repair of facial fractures at the West Virginia University Medical Center was carried out. Blindness developed in at least one eye in 21 (6%) of the 379 patients studied. Le Fort II and Le Fort III fractures, frontal bone and frontal sinus fractures, severe fractures of the zygoma, and fractures of the orbital floor were associated with fractures of the lesser sphenoid wing and optic canal in 5 of the patients studied. These 5 patients had indirect optic nerve injuries, as determined by CT scan and clinical criteria, which included visual loss with afferent pupillary defect and an otherwise normal ophthalmologic examination. In addition, one other patient who was not one of the 379 patients who underwent operative repair gradually developed ipsilateral blindness as a result of indirect optic nerve injury following minimal frontal bone trauma without a fracture. The usual mechanism of injury was trauma at the level of the orbital roof. The principal findings on CT scan were those of fracture of the lesser sphenoid wing and subdural hematoma of the optic nerve sheath. The association between sphenoethmoid sinus hemorrhage and fracture of the optic canal (31%) in cases of facial trauma has been presented. The indications for optic nerve decompression have been discussed. To the authors' knowledge, there is no previous report of an optic canal fracture as diagnosed by computerized tomography in the literature.

The diagnosis of CSF rhinorrhea by metrizamide CT scanning

A case of cerebrospinal fluid rhinorrhea is presented in which routine diagnostic evaluation failed to disclose the site of leakage. Computerized tomography (CT) scanning with metrizamide, a nonionic contrast medium, provided not only documentation of the leak but also demonstrated the actual sinus involved. Metrizamide cisternography with CT scanning is a valuable technique in the evaluation of CSF rhinorrhea. It may only be used when an active leak is present. The patient described in this report lost several drops of CSF from the nose per minute in the face-down position. Neurotoxicity may be avoided by routine pre-examination medication with valium or phenobarbital. Mixing of the contrast agent with CSF is diminished by injecting in the subarachnoid space at C1-C2. The methods used in this examination and their indications are described, and the literature concerning metrizamide toxicity and pharmacologic properties reviewed.

Combined cranio-facial fractures

Clinically, fronto-maxillary injuries may constitute a diagnostic problem, as their severity need not correlate with the patient's general condition. To establish a definitive radiological diagnosis, both normal standard films and tomographs are required. These will help to identify fracture lines involving the base of the skull. Most serious among the complications which may be associated with fronto-maxillary injuries is the occurrence of cerebrospinal rhinorrhoea with potential ascending infection. Other complications include oculomotor dysfunction, obstruction of lacrimal drainage and nasal airways as well as dental malocclusion. Primary surgical management is indicated in compound fractures, suspected intracranial haemorrhage and compression of the optic nerve, while fractures with associated dural injuries and involvement of orbital roofs as well as all other combined maxillo-facial fractures with functional impairment require early secondary management. Open exposure of the fracture site is best obtained through a coronal hair-line incision. Dural injuries are preferentially approached through craniotomies.

Radiology of basilar skull fractures

Injury to the basal portion of the anterior, middle, and posterior fossae of the skull are rather easily overlooked unless the radiologist carefully searches for indirect or direct signs of such injury. Representative injuries of each area are reviewed and radiological signs are illustrated. Combination fractures transversing several areas are also considered and illustrated.

[Gammacisternography and fronto-basal head injuries (author's transl)]

The authors give the results of 65 radioisotopic cisternographies for suspected rhinorrheas in frontal basal head injuries. Indium 111-DTPA lombar injection allows the investigation at least for 48 hours. After localisating the CSF fistulae, the gammacisternography permits us to study associated CSF circulation anomalies. Results and discussion give the correlation between positive tests and surgical findings. The best successful conditions of exploration are enough activity and a fluent clinical leakage of CSF. Nasal coton pledgets improve the success of the exploration.

Optic nerve injury in fracture of the canal

A case of unilateral blindness following blunt injury to the skull is presented. The patient died 4 days after the initial injury, presenting the rare opportunity of a detailed histopathological study of the acute features of the condition. The findings are discussed in the context of current theories of the pathogenesis of optic nerve injury in fractures of the optic canal.

Venous occlusions of the cavernous area--a complication of crushing fractures of the sphenoid bone

Four patients who sustained crushing fractures of the sphenoidal bone had angiographic evidence of venous occlusions of the cavernous area. Signs depended upon the type of basal venous and cavernous anatomy. The diagnosis can be made by demonstrating abrupt cutoff of veins in the cavernous region, preferred retrograde flow of the anterior cavernous sinus, direct venous hemorrhage, and venous stasis.

[Traumatic pneumocephalus]

Five patients with traumatic pneumocephalus are reported. A case with traumatic ventricular and subarachnoidal pneumocephalus resulting from damage to the sphenoidal sinus is described. Treatment of traumatic pneumocephalus is nonoperative is nonoperative in most cases.

Optic canal fractures after rhinologic surgery

In two women, 26 and 24 years old, respectively, polytomography revealed optic canal fractures. The investigation of visual loss after orbital or otolaryngologic surgery included tomography of the optic canals to rule out compression of the intracanalicular optic nerve.

Unilateral fracture of the pterygoid process. Report of a case

An unusual case of an isolated unilateral fracture of the pterygoid process is presented. The symptoms include a primary malocclusion as well as paresthesia of the major part of the maxillary nerve, indicating maxillary and/or mandibular fracture with dislocation of the fragments. The symptoms related to the regional anatomy as well as the mechanism of origin of the fracture are discussed.