A frequent pattern with two distinct fractures is a mandibular angle or subcondylar fracture with a contralateral parasymphyseal fracture. Another critical pattern, a flail mandible, consists of bilateral subcondylar fractures with a symphyseal fracture. In addition to these osseous injuries, fractures of the mandible may damage the inferior alveolar nerve because they extend through the mandibular canal. Beyond the mandible, approximately 20% to 40% of patients with mandibular fractures have further injuries [97]. CT Maxillofacial MDCT is useful in diagnosing maxillofacial injuries [2,30,31,37-43]. MDCT offers superb delineation of osseous and soft-tissue structures. CT provides high image resolution with thin-section acquisitions allowing for the detection of subtle nondisplaced fractures of the facial skeleton. CT is superior to radiography for the evaluation of mandibular fractures [96]. Nearly 100% sensitive with an improved interobserver agreement, CT with multiplanar reformations is proficient in detecting fractures of the mandible [31,99]. This is especially true of posterior mandibular fractures [3,100]. According to one study, more fractures are identified on CT when there is no fracture visible on orthopantomogram (OPG) [99]. CT is beneficial when evaluating ramus or condyle fractures, because the degree of displacement in these areas can be subtle [101]. CT is especially useful in identifying comminution and displacement of mandibular fractures. These are critical findings because they result in a change in surgical management [100,102,103]. Also, CT offers both multiplanar and 3-D image reconstructions, which allow for better characterization of complex fractures. In particular, many surgeons find the 3-D reformations afforded by CT to be critical in their preoperative planning [13,15,21,39,41,44-46]. CT allows for a faster acquisition time than other modalities such as radiography and MRI.
Imaging of Facial Trauma Following Primary Survey. A frequent pattern with two distinct fractures is a mandibular angle or subcondylar fracture with a contralateral parasymphyseal fracture. Another critical pattern, a flail mandible, consists of bilateral subcondylar fractures with a symphyseal fracture. In addition to these osseous injuries, fractures of the mandible may damage the inferior alveolar nerve because they extend through the mandibular canal. Beyond the mandible, approximately 20% to 40% of patients with mandibular fractures have further injuries [97]. CT Maxillofacial MDCT is useful in diagnosing maxillofacial injuries [2,30,31,37-43]. MDCT offers superb delineation of osseous and soft-tissue structures. CT provides high image resolution with thin-section acquisitions allowing for the detection of subtle nondisplaced fractures of the facial skeleton. CT is superior to radiography for the evaluation of mandibular fractures [96]. Nearly 100% sensitive with an improved interobserver agreement, CT with multiplanar reformations is proficient in detecting fractures of the mandible [31,99]. This is especially true of posterior mandibular fractures [3,100]. According to one study, more fractures are identified on CT when there is no fracture visible on orthopantomogram (OPG) [99]. CT is beneficial when evaluating ramus or condyle fractures, because the degree of displacement in these areas can be subtle [101]. CT is especially useful in identifying comminution and displacement of mandibular fractures. These are critical findings because they result in a change in surgical management [100,102,103]. Also, CT offers both multiplanar and 3-D image reconstructions, which allow for better characterization of complex fractures. In particular, many surgeons find the 3-D reformations afforded by CT to be critical in their preoperative planning [13,15,21,39,41,44-46]. CT allows for a faster acquisition time than other modalities such as radiography and MRI.