S. Guenkel

Asymmetry in odontoid-lateral mass interspace in trauma patients is a common finding that regularly leads to additional diagnostic work-up, since its dignity is not entirely clear. There is little evidence in the literature that atlantoaxial asymmetry is associated with C1–C2 instability or (sub) luxation. Asymmetry in odontoid-lateral mass interspace seems to occur occasionally in healthy individuals and patients suffering a cervical spine injury. Congenital abnormalities in odontoid-lateral mass asymmetry may mimic an atlantoaxial asymmetry. The center of C1–C2 rotation is based in the peg of dens axis; therefore, a C1–C2 rotational influence seems unlikely. So far, no study examined the influence of C0–C1–C2 tilt to an asymmetry in odontoid-lateral mass interspace. In order to determine if rotation or tilt influences the lateral atlantodental interval (LADI) and to estimate physiologic values, we examined 300 CT scans of the cervical spine. The mean LADI was 3.57 mm and the mean odontoid-lateral mass asymmetry was 1.0 mm. Head position during CT examination was found to be rotated in 39 % of the cases in more than 5°. Subsequent mean C0/C2 rotation was 4.6°. There was no significant correlation between atlantoaxial asymmetry and head rotation (p = 0.437). The average tilt of C0–C1–C2 was found to be 2°. We found a significant correlation between tilt of C0–C1–C2 and asymmetry in odontoid-lateral mass interspace (p = 0.000). We conclude that an atlantoaxial asymmetry revealed in CT scans of the cervical spine occurs occasionally. Since head tilt correlates with an atlantoaxial asymmetry, it is crucial to perform cervical spine CT scans in a precise straight head position.

Pfählungsverletzungen am Kopf und im Gesicht sind selten. Wir berichten über den Fall eines 48-jährigen Patienten, der sich beim Skifahren eine Pfählungsverletzung des Gesichtschädels mit einem 11 cm langen Ast zugezogen hatte. Der Patient präsentierte sich bei der Einlieferung in die Klinik neurologisch unauffällig und kreislaufstabil. In den CT-Untersuchungen des Kopfs konnten Frakturen im Gesichtschädel und ein 11 cm langer Fremdkörper, ausgehend vom Sinus maxillaris durch den Gesichtschädel bis paravertebral reichend, ohne Verletzung von Gefäßen nachgewiesen werden. Zusätzlich zog sich der Patient Frakturen an der Hand und an den Rippen zu. Er wurde in ein Zentrum für Kiefer- und Gesichtschirurgie verlegt, mehrfach operiert und konnte 8 Monate nach dem Unfall wieder in sein gewohntes privates und berufliches Leben zurückkehren. Facial perforation injuries are very rare. We describe a case of a 48-year-old man who sustained a perforation trauma from an 11 cm long wooden tree branch in the middle of the face in a skiing accident. He suffered from additional injuries, such as fractures of the ribs and hand, but was neurologically without pathologic findings and was cardiopulmonary stable. The branch penetrated the head from the sinus maxillaris through the maxilla just missing the internal and external carotid arteries and ending just short of the cervical vertebra. The patient was transported to a center for oral and maxillofacial surgery and underwent several operations. He could return to his normal social and professional life 8 months after the accident.