Total Smash

Smash fractures constitute otherwise unclassified extensive comminuted facial fractures that occur from high-impact trauma. These fractures are associated with extensive intracranial injuries given their mechanism of occurrence. Smash fractures have been subdivided into multiple categories including frontal smash, nasoethmoid smash, central midface smash, and total craniofacial smash.

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Images show a total facial smash fracture pattern with severe comminution of the left frontal bone. Multiple fragments of the left frontal bone are displaced into the left orbit. Superior displacement of the left globe and a retroconal hematoma are seen. A comminuted fracture of the left sphenoid bone produces two fragments at the level of the orbital apex that appear to impinge on the superior orbital fissure and neurovascular structures. Fractures through the left frontozygomatic and zygomaticotemporal sutures are seen, along with fractures through the left zygomatic arch. A right frontal bone fracture extends into the pterion and may connect with the left frontal fracture via the frontoparietal suture. The fracture line extends into the right orbital roof. Bilateral anterior and lateral wall maxillary fractures, along with comminuted bilateral nasal bone and ethmoid bone fractures are seen. Fractures are seen extending through the pterygoid plates bilaterally.

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Coronal image demonstrates multiple bony fragments from the left frontal bone inferomedially displaced into the left orbit. Fracture of the right frontozygomatic suture can be appreciated.

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A more anterior coronal image demonstrates comminution of the left frontal bone with bony fragments displaced distantly in the soft tissues. Fracture of the right frontozygomatic suture and bilateral orbital emphysema can be appreciated.

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Sagittal image demonstrates comminution of the left frontal bone with bony fragments displaced into the orbit. Anterosuperior displacement of the left globe can be appreciated. A displaced fracture of the sphenoid bone is seen.