Spectrum of Critical Imaging Findings in Complex Facial Skeletal Trauma

Abstract

Multidetector computed tomography (CT) is the modality of choice for the evaluation of facial trauma because it helps accurately identify and characterize fractures and associated complications, thereby aiding timely clinical management and surgical planning. In particular, CT clearly depicts clinically relevant fractures in the eight osseous struts or buttresses that function as an underlying scaffold for facial structures. Information about the involvement of specific facial buttresses in a complex fracture is helpful for determining the type of fracture present and for identifying associated soft-tissue injuries that may require urgent care or surgery. Various kinds of complications can be expected to occur in Le Fort fractures, which affect the full thickness of the pterygoid plates, with resultant dissociation of part or all of the maxilla from the skull base; naso-orbitoethmoid complex fractures, which involve the medial orbital wall, nasal bone, ethmoid sinuses, and, often, the attachment site of the medial canthal tendon; zygomaticomaxillary complex fractures, which disrupt all four zygomatic sutures and may lead to enophthalmos due to increased orbital volume because of angulation of the lateral orbital wall; orbital "blowout" fractures, which may result in extraocular muscle herniation or entrapment and injuries to the globe or the infraorbital nerve; and fractures of the alveolar process, which are treated as open fractures because of their extension through the gingiva to the oral cavity and their resultant vulnerability to infection. Similarly, extension of a frontal sinus fracture through the posterior sinus wall creates a portal to the anterior cranial fossa and may lead to cerebrospinal fluid leakage, intracranial hemorrhage, or intracranial infection.

Demystifying Orbital Emergencies: A Pictorial Review

“…They include Le Fort II fractures involving the medial wall and orbital floor; Le Fort III fractures involving the medial and lateral orbital walls; naso-orbitoethmoid (NOE) complex fractures involving the medial orbital wall and often the attachment site of the medial canthal tendon; zygomaticomaxillary complex (ZMC) fractures involving the orbital floor and lateral wall; and orbital blow-out fractures (26). Because of comminution of the medial orbital wall, one possible complication of NOE fractures is traumatic telecanthus from a medial canthal tendon injury.…”

Postoperative CT of the Orbital Skeleton After Trauma: Review of Normal Appearances and Common Complications

“…The goal of surgical repair is to restore facial symmetry and orbital volume with internal fixation of the displaced sutures using plates and screws [10]. Because the zygoma contributes to the orbital floor in addition to the lateral wall, concomitant fractures involving more than 50% of the floor will require reconstruction.…”

“…The number of patients requiring additional surgeries after their original treatment remains comparably unchanged, which serves as an indicator of the challenge that orbital fracture reconstruction poses [3]. There has been much focus in the literature on identifying orbital fracture patterns on CT at the time of the initial injury [4][5][6][7][8][9][10], although a paucity of information exists regarding interpretation of CT after orbital fracture repair. The aim of this article is to introduce indications for surgical repair of orbital fractures and to describe both the desired CT appearance of the orbital skeleton after fixation as well as some of the more commonly encountered complications.…”

Neuroimaging in adult penetrating brain injury: a guide for radiographers

“…CT is advantageous over other imaging modalities due to it being readily available, able to acquire images quickly, sensitivity for head injuries and high image resolution available with thin-section acquisitions 20–22…”