By Cynthia Dermody
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Because the bleeding is under arterial pressure, it generally accumulates quickly, causing a mass effect with shift of the ipsilateral hemisphere and, eventually, transtentorial herniation. Some small EDHs never progress to this stage and can be managed conservatively. The diagnosis of EDH is based on CT scan that reliably demonstrates the typical hyperdense accumulation of blood in a lenticular shape at the periphery of the cerebrum, indenting the cerebral cortex and brain parenchyma. Outside of the posterior fossa, the hematoma will not cross suture lines, as the dura is tightly adherent at suture lines.
Photograph of the eye showing a scleral laceration with exposure of the choroid (arrow). This is highly suggestive of rupture of the globe. 4D. Photograph of a ruptured globe with a peaked pupil (arrow A), laceration of the inferior/lateral sclera (arrow B), and bulging chemosis (arrow C). The peak in the pupil points toward the laceration. 4B. Photograph of a patient with enucleation and destruction of the eye. 4E. CT scan showing destruction of the right eye with intraocular bone fragments and periorbital fractures.
A pressure dressing is applied to prevent reaccumulation of the hematoma or abscess formation. Avulsed cartilage from the ear or nose should be preserved in saline, as it is difficult to re-create the shape of these organs with other tissues. Most facial fractures can be repaired electively with operative fixation and bone grafting if necessary. Intraoral lacerations are repaired with absorbable sutures. Antibiotics are unnecessary for most facial lacerations, although open fractures require prophylactic coverage.