35yrs/M patient presented to casualty after being struck by an Car through a pedestrian cross walk.On examination he appeared to be drowsy and irritable with BP - 140/90,HR - 104,GCS - E3M5V3,Pupils - Right blown pupil,Left 4mm RTL.APPROACH?

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Multiple # rt frontal, # rt maxilla,subgalial swelling rt,diffuse pneumocephalus,small contusionv rt frontal lobe.Duffuse Brain edema with effacement of sulci rt more than left. RT lateral ventricle frontal horn is compressed due to brain edema. Suggest conservative treatment. Neurosurgical and ENT opinion

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A maxillo- facial injury with fractures and right frontal bone fracture with associated sinus injury with PNEUMO- ENCEPHALUS with cerebral oedema . Conservative treatment with decongestive therapy, AED s, and once general condition improves a neurosurgical and maxillo- facial consultation is needed

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Multiple # on rt frontal and facial structure including maxilla, mandible and other sinuses Leading to Pneumocephalus management for neurological condition under neurosurgeon observation and also take help from Maxillofacial surgeon Also look for any airway injury which may increase air in crenium.

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Agree@Dr. Manorama Rajan Madam Ji

Pneumoencephalocele with sinus injury Conservative with antibiotic coverage

Fracture of frontal bone (rt) , maxillary bone , mandibular bone , involvement of sinus and edema formation in the brain .

I am agree with@Dr. Manorama Rajan ma'am.

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