Facial Bone X-Ray Interpretation Checklist
1. Look for tripod fracture
 • Find the zygoma and fan out in 3 directions
 • First look at the frontal process of the zygomatic bone and check if the frontozygomatic suture is widened
 • Next follow the inferior orbital rim and then the zygomatic arch (or the 'elephant trunk')
 • Whilst here also fan out in a fourth direction and track the lateral wall of the maxillary antrum
 • With each step you are looking for a break in the cortex and a possible fracture - if in doubt compare to the other side
2. Assess orbit and maxillary antrum
 • Now check the integrity of the walls of the orbit and maxillary antrum
 • Look for a fluid level in the maxillary antrum which can be a secondary sign of fracture but beware can also reflect sinusitis
 • Look for a dark rim at the superior end of the orbit ('black eyebrow sign') reflecting gas in the context of a blowout fracture
 • Look for bulging of soft tissue below the inferior orbital rim representing herniated intra-orbital fat in the context of an orbital blowout fracture
3. Assess the lower half
 • Now outline the mandible looking for a break in the cortex
 • Also cast an eye on the odontoid peg

by Dr. Naveen Sharma - theRadiologist @radiologistpage

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