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The patient is a 32-year-old man who presents after experiencing a blow to the face while falling from a bicycle.
The patient complains of tenderness over the front of his face. Neurological exam is normal. You note that his neck is supple.

View the image taken (Figure 1) and consider what your diagnosis and next steps would be.


Resolution of the case is described on the next page.

Clinical Challenge 2: September 2010

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services