The patient described above has also suffered major facial trauma. Which of the following statement(s) is/are true?

d. Coronal CT scan images can be a useful adjunct to the evaluation of the patient with facial and head injuries

A major cause of maxillofacial trauma are motor vehicle accidents. Facial skeletal fractures and soft tissue damage in the frontal, orbital, nasal, zygomatic, maxillary and mandibular regions are included. The frontal bone, which houses the frontal sinuses, is particularly strong due to its arched configuration as well as thick, hard bone. The amount of force necessary to fracture the frontal sinus is two to three times greater than that necessary for other facial bone fractures. Consistent fracture patterns from blows to the maxilla have been classified by LeFort and occur within and along the maxilla at its junction with weaker and aerated bone of the paranasal sinuses and nasal cavity. The classic LeFort fractures are classified as LeFort I, LeFort II and LeFort III and are of increasing complexity and morbidity. The cribriform plate, ethmoidal arteries, optic nerve and internal maxillary artery are all vulnerable to injury with a LeFort III fracture.

Soft tissue injuries of the face are encountered even more often than facial fractures. The facial nerve is the most important underlying structure at risk since blunt or penetrating trauma to the nerve or branches can cause complete or partial ipsilateral facial paralysis. The most common cause of facial nerve injury is fracture of the temporal bone, but injury can occur anywhere from the intracranial to the extracranial facial course of the nerve. After securing the airway and controlling life-threatening hemorrhage, the secondary survey including the facial area is carried out. The nose is inspected for deformity, pain, mobility, septal hematoma and obstruction. Bleeding should be managed immediately. Leakage of cerebral spinal fluid suggests a cribriform plate or ethmoidal fracture and a presence should warn against insertion of any nasal tubes or packing. Since CT scan is part of the standard management of the head-injured patient, sections of the facial skeleton can be obtained simultaneously, providing information on the extent of facial fractures in addition to the status of the brain. Axial and coronal sections (obtained with the patient’s head hanging with the neck extended) are complimentary and are especially helpful in delineating the cribriform plate and ethmoid roof region, the orbital rims, and the overall vertical facial height.