Also, MRA with or without IV contrast is time-consuming, making it challenging to use in an acute trauma setting. Some debate exists as to whether CTA is superior to MRA in BCVI. One study found CTA to be superior [68], whereas another found them to be equivalent [29,69]. Virtual arteriograms can be created without IV contrast using time-of-flight or phase-contrast sequences. Nevertheless, pseudoaneurysms or subtle stenoses are more easily detected by administering contrast intravenously using 3-D time-of-flight imaging. As stated above, BCVI, although uncommon in maxillofacial trauma, carries significant morbidity and mortality if not identified and treated early. Therefore, the exclusion of these injuries is necessary in the correct clinical context. Despite improvements in CTA and MRA, the reference standard for identifying cervical arterial injury remains arteriography because of its ability to detect low-grade injuries missed on other modalities [29,70-72]. However, CTA or MRA is generally utilized over arteriography currently, secondary to the 1% to 2% risk of meaningful complications such as stroke and dissection [29]. Radiography Chest There is no relevant literature to support the use of chest radiography in the initial imaging evaluation of suspected midface injury. However, a chest radiograph may be warranted to exclude tooth aspiration if there is a tooth that is absent [46,83]. A physician or surgeon should remove an avulsed tooth in the airway because of the risk of developing obstructive pneumonia [9]. Imaging of Facial Trauma Following Primary Survey cosmetic deformity and nasal obstruction [32]. In particular, a fracture involving the nasal cartilage may cause a septal hematoma leading to cartilage necrosis or resorption, and if untreated, a subsequent saddle nose deformity. US Maxillofacial Ultrasound (US) is typically not the first-line imaging test for evaluation of nasal injuries.
Imaging of Facial Trauma Following Primary Survey. Also, MRA with or without IV contrast is time-consuming, making it challenging to use in an acute trauma setting. Some debate exists as to whether CTA is superior to MRA in BCVI. One study found CTA to be superior [68], whereas another found them to be equivalent [29,69]. Virtual arteriograms can be created without IV contrast using time-of-flight or phase-contrast sequences. Nevertheless, pseudoaneurysms or subtle stenoses are more easily detected by administering contrast intravenously using 3-D time-of-flight imaging. As stated above, BCVI, although uncommon in maxillofacial trauma, carries significant morbidity and mortality if not identified and treated early. Therefore, the exclusion of these injuries is necessary in the correct clinical context. Despite improvements in CTA and MRA, the reference standard for identifying cervical arterial injury remains arteriography because of its ability to detect low-grade injuries missed on other modalities [29,70-72]. However, CTA or MRA is generally utilized over arteriography currently, secondary to the 1% to 2% risk of meaningful complications such as stroke and dissection [29]. Radiography Chest There is no relevant literature to support the use of chest radiography in the initial imaging evaluation of suspected midface injury. However, a chest radiograph may be warranted to exclude tooth aspiration if there is a tooth that is absent [46,83]. A physician or surgeon should remove an avulsed tooth in the airway because of the risk of developing obstructive pneumonia [9]. Imaging of Facial Trauma Following Primary Survey cosmetic deformity and nasal obstruction [32]. In particular, a fracture involving the nasal cartilage may cause a septal hematoma leading to cartilage necrosis or resorption, and if untreated, a subsequent saddle nose deformity. US Maxillofacial Ultrasound (US) is typically not the first-line imaging test for evaluation of nasal injuries.