31 - CT Imaging of the Face

Summary

CT has surpassed plain film radiography as the method of choice for rapid and efficient facial fracture identification in the multitrauma patient and the patient with isolated injuries to the face. One key reason is that plain film radiography facial views, such as the Waters' view, require repositioning to overcome the problem of overlapping structures obscuring fracture assessment. This is problematic because trauma patients often arrive with a rigid cervical collar in place. CT bypasses this problem and allows for simultaneous evaluation of facial trauma during emergent assessment for intracranial and cervical spine injury. CT images depict all areas of the facial skeleton without the need for repositioning, allow for accurate identification of exact bones involved in a facial fracture, and provide detail into the degree of fracture displacement and the extent of soft tissue involvement. 3D images constructed from CT images are also useful to direct presurgical planning. The qualities listed here make CT the preferred diagnostic tool in suspected fractures involving the thin bones of the orbit and midface. CT is also preferred for multitrauma patients exhibiting clinical signs of orbital involvement and when soft tissue swelling prevents adequate clinical assessment (1–4).

In the multitrauma patient, a head CT is routinely performed to screen for intracranial injury.