Med Legal: Facial Trauma — Winter Kraemer Portfolio

Facial Trauma - Medical Legal Illustration
Medical legal illustration involves clarifying complex injuries to jurors with unknown expertise. Illustrating a facial trauma case is especially tricky: how do you balance effective communication and a sense of empathy for the patient without verging on gratuitous gore?

This piece was based on anonymized case files from a client in a motorcycle accident. He sustained multiple jaw and skull fractures with accompanying soft tissue lacerations. The illustrations are intended to be presented with a verbal explanation from a medical expert.

Audience

Jury (general audience)

Tools

Adobe Illustrator, Procreate

Client

Prof. Stephen Mader (University of Toronto)

Content experts

David Aten, CMI (University of Texas MD Anderson Cancer Center)
Prof. Dave Mazierski (University of Toronto)

Reports & Research

Our team was tasked with piecing together a narrative from a stack of medical reports and CT scans. We analyzed two years worth of reports to parse a logical timeline from the initial motorcycle injury to surgeries, and finally, post-traumatic complications.

Fractures

Using the 3D model provided in the case files, I analyzed the fractures and compared them to literature on mandibular fracture patterns. Given the asymmetrical distribution of teeth lost, I surmised that the force on his face shifted his jaw to his right, and caused overlapping of the condylar necks. This, along with the parasymphyseal (chin) fracture is a typical break pattern for an anterior force to the jaw.

The patient had a Le Fort type I fracture pattern, indicating a full maxillary break below the nasal aperture. CT scans were analyzed carefully to evaluate the depth of overlap between the parts of the maxilla.

After careful analysis, I assembled a sketch that emphasized all fractures visible from an A/P view. Lacerations were overlaid on low opacity to ensure that soft tissue injury and bony injury were aligned to one another.

Missing Teeth

John Smith had a surprising lack of teeth, even before the accident that removed another six. To clarify the case files, I consulted with a faculty member who is versed in dental anatomy (Prof. Dave Mazierski). He informed me that upper and lower premolars may be absent at birth, which explained the four missing teeth (other than wisdom teeth).

I developed a dental chart of my own to communicate with my group members and ensure that we were all on the same page about missing teeth.

Lacerations

Showing soft tissue injury was the most challenging aspect of this piece. I pieced together information from the reports, including a rough sketch of lacerations on an intake form.

In order to recreate the lacerations as accurately as possible, I consulted with a medical illustrator (David Aten, CMI) with experience in medical legal illustration. He walked me through how to use Horos to isolate soft tissue windows to confirm the laceration placement.

Finally, I depicted the intense swelling that John Smith suffered surrounding his fractures. This choice drives home the sense that Mr. Smith’s case was a major injury with major consequences. I wanted to show the full extent of the injury without verging on the prejudicial.

Design Choices

Original designs included a cervical collar to reflect the patient’s state when brought into the emergency room. It was ultimately removed because it obstructed the view of the open chin fractures. Considering the severity of these injuries, it was critical to show them clearly. Swelling and bruising were also difficult to emphasize with the collar. I employed realism and vivid colours for the injuries to ensure that the severity of Mr. Smith’s was evident.

Final comprehensive sketch

Professional Practice

Finally, our instructor emphasized the importance of professional conduct in the context of medical legal illustration contracts. Part of our team’s work was to create opening and closing cover letters, a quote, and an invoice. This encouraged our team to think carefully about which pieces were important to show and how we would present this to a lawyer. Personally, it helped me to delineate the role of a medical legal illustrator as not a legal expert yet aware of certain aspects of medical litigation.

To maintain cohesive branding, I created a logo and name for my team’s “studio”: Head & Shoulders Inc. (not affiliated with the shampoo company).

Reach out whenever :^)

kraemerwinter@gmail.com