Figure 13b. Medium-energy injuries to the left orbital floor and zygomatic complex in a 10-year-old girl after a motor vehicle accident. (a) Axial CT image at the level of the midface shows an impacted left zygomatic complex fracture that involves the zygomatic process of the maxilla and a secondary fracture of the anterior and lateral wall of the maxillary sinus. Note the accumulation of blood in the sinus and the inflammation of periorbital soft tissue. (b) Axial CT image shows a fracture of the lateral wall of the left orbit with several displaced fragments (arrows). (c) Coronal reformatted CT image obtained with bone window settings shows fractures of the frontal (black arrowhead) and maxillary (white arrow) zygomatic processes and a fracture of the orbital floor with a displaced fragment (white arrowhead) and herniation of orbital contents into the maxillary sinus (black arrow). A nondisplaced fracture of the zygomatic arch also was present (not shown). (d) Coronal reformatted CT image obtained with soft-tissue window settings shows that the prolapsed tissue is orbital fat (arrow). The inferior rectus muscle was displaced, but there was no sign of impingement. Intraorbital gas bubbles (*) are suggestive of a paranasal sinus wall fracture. Note the fissure of the right middle turbinate (arrowhead).