Learning objectives
To demonstrate the findings in different types of facial fractures and the information that a radiologist's report should contain in order to guide the maxillofacial surgeon.
Background
Facial traumas are frequent results from traffic or working accidents,
aggressions or accidental drops .
The imaging technique of choice is the TCMD due to its high resolution in terms of space,
velocity,
easy collocation of the patient,
small dependency on its collaboration and the possibility to realize multi planar reconstructions in 2D or 3D.
It is important to create coronal slices and 3D models which permits the surgeon to define the range of the fracture lines.
We divide the face into five anatomic areas...
Imaging findings OR Procedure details
PATTERNS OF FRACTURES
Nasal fractures: evaluate the involvement of the nasal septum
Classification:
Simple fractures: unilateral or bilateral,
involving exclusively the nasal bones,
with possible deviation of the nasal septum
Comminuted fractures: Unilateral or bilateral,
can include the anterior maxillary spine
Complex nasal fractures: Fracture or dislocation of the bony or cartilaginous nasal septum
(Figure 2)
Naso-orbital-ethmoid fractures: Involved are the medial vertical buttresses and the upper transverse maxillary buttress.
We have to pay especial attention to the grade of fragmentation in the middle maxillary...
Conclusion
The MDCT is the fundamental technique to detect and characterize facial traumas.
It is necessary to realize multi-planar reconstructions,
especially in coronal section and 3D reconstruction in order to perform a correct classification.
The radiologist has to know the facial buttresses and the most frequent patterns of facial fractures.
It is important that he looks for those fractures that require surgical treatment in order to inform and guide the surgeon,
instead of simple listing of radiologic findings.
References
1.
Hopper R,
Salemy S,
Sze R.Diagnosis of Midface Fractures with CT: What the Surgeon Needs to Know. RadioGraphics 2006; 26:783–793.
2.Avery L,
Susarla S,
Novelline R.Multidetector and Three-Dimensional CT Evaluation of the Patient With Maxillofacial Injury. Radiol Clin N Am 49 (2011) 183–203.
3.Som P,
Brandwein M.
Facial Fracture and Postoperative Findings.
In Som P,
CurtinH,
Head and Neck Imaging.
(374-439) St Louis (MO).
Mosby-Doyma.
2003.
4.Alcalá-Galiano,
A,
Arribas-García I,
Martín-Pérez M et al.
Pediatric Facial Fractures: Children Are Not Just Small Adults.
Radiographics...