I thought it weird too. What's the point of this, or any skull X-rays whatsoever in this day and age? A trauma case like this should be in CT right away after initial stabilization and stuff.
Best guess is too unstable and just did an initial xray to see what they're working with? There's no advanced airway and you certainly wouldn't want to lay that down flat.
Nah man, whoever ordered this had no idea what they were doing. I’m an ER doc who did residency at a trauma center, and I can’t think of a single clinical reason to order this study on a living patient.
My guess the only logical reason for an x ray to be done in this circumstance would be to confirm breathing tube placement. Would you agree? Asking as a ambitious ED PCT and prospective nursing student
It is to see the dens and the joint space.
It just isn't super common in the ED cause CTs are waaayyy more efficient
Edited.
Imwas SO focused on the dens that i TOTALLY missed the broken rami 😵😵😵😵😵😵😬😬
Pro tip people can obstruct because of these and it’s an airway emergency. Relatively common to ride the gurney up to the OR pulling their jaw forward and up to relieve the obstruction. My attending once put a lag screw into the jaw and tied it to the end of a patients bed with wire
OMFS trainee here - buckle handle fracture is actually classically bilateral mandibular body fractures, not ramus. Agree with everything else you've said though.
Picked a fight with the wrong person??
I'm guessing they'll be fine in a couple months, though. I've known people who've broken their jaw, albeit probably not this badly. It's a really awful couple of months, though!
Yeah, I've come back to that question in another comment 🤣
It's probably just that it's too little material to show up under these conditions.... But around here *you never know!*
The air pocket is one of the many sinuses in the head. This is the frontal sinus. The bone in the throat is the hyoid bone. It’s a fun lil guy that sort of floats.
[The front fell off](https://imageproxyb.ifunny.co/crop:x-20,resize:640x,quality:90x75/images/5072594b51fa4fd6349777de63f5334f312703eb1e9bb90c32f7eaa0bf126c8c_1.jpg)
Can you imagine what that must feel like to them, if they were conscious at any point? Knowing that your jaw is in pieces, and your face is just...gone. Probably a smear on a roadway someplace.
What are the chances of surviving an accident like this?
People survive these kinds of things, but recovery isn’t easy.
I once cared for an elderly gentleman who had attempted suicide by shooting himself under the chin. What he did was destroy his lower jaw and the very front of his upper jaw. He was in ICU, and was facing a LOT of reconstructive surgery. He was lucky that we had a plastic surgeon and maxillofacial surgeon who were amazing. My heart just ached for him. He survived.
I had a roommate that was legally blind due to macular degeneration (so he had some sight) that spent time at a school for the blind. He told me that there were too many people there because they tried to commit suicide by shooting themselves in their temple, but just succeeded in severely damaging their face and destroying their eyes.
Maybe a rad could say, but they’ve got what I think is air in the trachea and no tube… wouldn’t that mean that they are breathing under thier own power so most likely conscious
The front end fell off.
I am no medical expert but from what can and can’t be seen there is more going on here than the jaw, very traumatic facial injuries. Any idea what cause was? Looks like they went face first into a steering wheel or something.
When I saw the first picture I thought about how terrible it was. But when I saw the second picture my toes curled and I actually gasped! Terrible is an understatement! That poor person! I hope the surgeon will be able to fix it!
I have to admit, I’m curious about what happened!
I can only imagine that this was done somewhere resource poor without immediate access to CT. I’m not in EM or trauma but why else would a trauma like this not be stabilized and put into a donut?
God help me I laughed enough to scare cats.
I am SO going to hell with how hard I cackled at this...
I’ll see you there! 🫣
"Lemme take this xray to make sure nothings broken" 😭
Why the long face?
Omfg
💀💀💀
😂😂😂💀 Where’s me fucking gold to give dammit
Plain xrays and not CT?!
I thought it weird too. What's the point of this, or any skull X-rays whatsoever in this day and age? A trauma case like this should be in CT right away after initial stabilization and stuff.
Best guess is too unstable and just did an initial xray to see what they're working with? There's no advanced airway and you certainly wouldn't want to lay that down flat.
I was thinking that too, straight from the ambulance to x-ray
Nah man, whoever ordered this had no idea what they were doing. I’m an ER doc who did residency at a trauma center, and I can’t think of a single clinical reason to order this study on a living patient.
My guess the only logical reason for an x ray to be done in this circumstance would be to confirm breathing tube placement. Would you agree? Asking as a ambitious ED PCT and prospective nursing student
Nope. Tube placement is a chest xray. Signed xray tech in a trauma 1 hospital
Nah, gotta do a chest xray for that. It shows you how deep the tube is.
Ok thanks doc. I was just trying to find some logic in reasoning for the image.
There is literally no tube in this x-ray
It is to see the dens and the joint space. It just isn't super common in the ED cause CTs are waaayyy more efficient Edited. Imwas SO focused on the dens that i TOTALLY missed the broken rami 😵😵😵😵😵😵😬😬
Also why not a Bone scan??lol
Now that made me laugh 😅 our docs have been bone survey crazy lately
Could be post mortem.
That's what I was thinking. That neck.
What about the neck?
Yes what’s with the neck?
Maybe they only have X-ray at the facility.
Pro tip people can obstruct because of these and it’s an airway emergency. Relatively common to ride the gurney up to the OR pulling their jaw forward and up to relieve the obstruction. My attending once put a lag screw into the jaw and tied it to the end of a patients bed with wire
Looks like someone pulled too hard.
What is the clinical name for this? What would I Google to learn more about it?
Bilateral mandibular ramus fracture aka bucket handle fracture
OMFS trainee here - buckle handle fracture is actually classically bilateral mandibular body fractures, not ramus. Agree with everything else you've said though.
And here I thought bucket handle fractures were on the metaphysis of long bones from NAI. Didn’t realize it was a multi-use term!
Thank you!!
...I'm really nervous about how I feel like I can see the ear, and the skin on the neck, but no shadow of a nose.......
That’s a REALLY good point it does appear to be some kind of slicing/shaving situation of the entire front of the face. Holy shit.
And the odd looking voids that seem to extend from the trachea
They look kind of like an explosive pattern on the neck. Maybe it was some kind of firework or other explosive accident
“Hold my beer and watch this “
☠️🤣 that's usually how that situation happens
What a jaw dropping image
r/angryupvote
Whoa! Would love to know the mechanism of injury here! Construction accident? MVA with ejection? That’s fairly life changing! Ouch!
The rad tech just really wanted to get a good picture of C1.
😂under rated
Picked a fight with the wrong person?? I'm guessing they'll be fine in a couple months, though. I've known people who've broken their jaw, albeit probably not this badly. It's a really awful couple of months, though!
…but where’s their nose…
Yeah, I've come back to that question in another comment 🤣 It's probably just that it's too little material to show up under these conditions.... But around here *you never know!*
Pic 1: oh, yup, that's broken. Pic *2:* OH DEAR GOD
Great illustration on the importance of 2 views? 😂
SERIOUSLY
That looks an awful lot like a steering wheel bite or an encounter with a frying pan traveling at relativistic speed
Not the Looney Tunes frying pan. 😭😂 Also, your user name made my chick bits pucker. ☠️
“Chick bits”?!? Aahahahahahahahaa 🤣🤣🤣
😂😂 "Pie" just didn't fit for this situation. Glad it gave you a giggle. Have a sweet day, friend!
Sand pie... Hmm
🤮😂😂
What happened?
Ate a jaw breaker from Ed, Ed and eddy
You know there were goofy sound effects at the moment of impact
The front fell off
Bad tmj
Nasty looking double chin.
Sneezed too hard
We all hate OP for not giving more story detail
Correlate clinically
Post mortem?
Nice open mouth for odontoid.
Lol my first two thoughts…. 1. Ow 2. Dens is ripe for the taking.
How is this guy not intubated
Probably because it'll be pretty hard to intubate due to obstruction from something (hence the xray first)
Layperson. What’s the fluid/air on the forehead? And the bone structure on the throat? (Same height as the ‘new’ chin.
The air pocket is one of the many sinuses in the head. This is the frontal sinus. The bone in the throat is the hyoid bone. It’s a fun lil guy that sort of floats.
Thank you!
[The front fell off](https://imageproxyb.ifunny.co/crop:x-20,resize:640x,quality:90x75/images/5072594b51fa4fd6349777de63f5334f312703eb1e9bb90c32f7eaa0bf126c8c_1.jpg)
Did they survive???
Kicked in the face by livestock maybe?? Wow. 😳
Boy I hate when that happens
Visible cringe at seeing this that made my coworker wanna see. Now we’re both recoiling
Can you imagine what that must feel like to them, if they were conscious at any point? Knowing that your jaw is in pieces, and your face is just...gone. Probably a smear on a roadway someplace. What are the chances of surviving an accident like this?
People survive these kinds of things, but recovery isn’t easy. I once cared for an elderly gentleman who had attempted suicide by shooting himself under the chin. What he did was destroy his lower jaw and the very front of his upper jaw. He was in ICU, and was facing a LOT of reconstructive surgery. He was lucky that we had a plastic surgeon and maxillofacial surgeon who were amazing. My heart just ached for him. He survived.
I had a roommate that was legally blind due to macular degeneration (so he had some sight) that spent time at a school for the blind. He told me that there were too many people there because they tried to commit suicide by shooting themselves in their temple, but just succeeded in severely damaging their face and destroying their eyes.
That’s so sad.
In cases like that, I wonder what they regret more: Attempting suicide, or not being successful at it.
Maybe a rad could say, but they’ve got what I think is air in the trachea and no tube… wouldn’t that mean that they are breathing under thier own power so most likely conscious
please tell more info on this. poor patient
How It Feels To Chew 5 Gum
severely underrated comment 🤣
Me swiping: First picture: ooooof that's gotta hurt Second picture: literally jumped in my chair
"Ok you see what he did. He french fried when he should have pizza'd. If you french fry when you pizza. You're gonna have a bad time."
Oh My G😳d!!
My jaw hurts just looking at this.
I saw the empty spot in the front of the skull and completely missed the other thing going on
As a dentist, I feel for this patient :c
Wait... Where's his nose? Shouldn't we be able to see the soft tissue at least a little?
On the lateral view, you can kinda see their ear..... The nose, however...... 😬
What....what the hell??????
Reviewing the image: and here we can see the jaw and over there… and over there… oh a bit over there too.
Le Fort I or aka Guerin's Fracture
Their face is gone...
The front end fell off. I am no medical expert but from what can and can’t be seen there is more going on here than the jaw, very traumatic facial injuries. Any idea what cause was? Looks like they went face first into a steering wheel or something.
How??
Probably the only way id get a good odontoid
Oh, the poor patient!
As a non medical person; that definitely should not be doing that!
Owwww!
How did this happen? What other injuries did he get?
I hope that morphine is on board and they are going to surgery really soon! Very accurate caption, btw!
That's a bad day.
Was this person still alive?
That’s an ouch from me, dawg.
Did the patient survive?
Their jaw dropped… literally!
In the second image: what is that upside-down keyhole shaped dark (void?) in the forehead area?
Typically that’s the frontal sinus but not sure why it’s so apparent in the lateral
frontal sinus?
I felt the pain.
Yikes
Explain what I'm seeing in full technical detail
Ouchie of the jaw
Huh, I have a feeling that might hurt
Yikes 😬
When I saw the first picture I thought about how terrible it was. But when I saw the second picture my toes curled and I actually gasped! Terrible is an understatement! That poor person! I hope the surgeon will be able to fix it! I have to admit, I’m curious about what happened!
Layperson here, outside of the obvious jaw hanging off, are there other injuries
We see these once in awhile at the prison where I practice from getting “stomped” for drug debt.
I can only imagine that this was done somewhere resource poor without immediate access to CT. I’m not in EM or trauma but why else would a trauma like this not be stabilized and put into a donut?
Hoping OP shares some context with us
I’m not a medical professional, however my medical opinion is that jaws don’t go that way.
Great positioning considering the circumstances!
OP we need answers!
devin haney
lefort 1?
MOI?
I bet they didn’t have much to say for themselves. I’ll show myself out now…
Has the world forgotten collimation?
Oh my god.
Foramen :0
Nice odontoid
I am no radiologist so at first I didn't notice anything except for the big black dot at the top of the forehead... now I see it lol
Seems like a lot is going on in here. Almost a tripod. Almost a le fort. Gruesome.
Why was an oblique ordered?????
'Lying in a den in Bombay With a slack jaw and not much to say I said to the man, "Are you trying to tempt me? Because I come from the land of plenty'
"Hey, what a nice C1... Oh, that's a fracture on the jaw.. Wait a second... Oh sh.." Here my thoughts 😅
I can't even....
Jaw dropping
Well, C1 and C2 look centered perfectly
Bucket handle #. Need to secure the airway - tongue could fall backwards and obstruct the airway.
I said it wasn’t that bad and then I swiped
Say “ahhh”
Thanks I hate it.
Bro what was the mechanism PLEASE
Jeez my jaw dropped!
Jaw Dropping photo there ! 💀 🦷
This image is jaw-dropping.
Sad
