Arteriography Cervicocerebral Angiography of the head and neck may logically follow identification of specific bony or soft tissue injuries but is not useful as the initial imaging modality to identify frontal bone injury. Angiography is used as a problem-solving Imaging of Facial Trauma Following Primary Survey 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]. addresses the role of imaging in the setting of head trauma. CT with IV contrast does not aid in detection of head injury. MRI Maxillofacial There is no relevant literature to support the use of MRI of the face in the initial imaging evaluation of suspected midface injury. However, in patients with cranial nerve deficits not explained or incompletely characterized by CT, MRI can be a useful supplement [31]. In particular, some Le Fort II injuries can disrupt the infraorbital nerve (V2), leading to anesthesia of the upper teeth, gingiva, upper lip, and lateral aspects of the nose [15,32,80]. Zygomatic maxillary complex fractures are often associated with infraorbital nerve (V2) deficits as well [4,79]. In naso-orbital- ethmoid fractures, olfactory nerve injury often occurs. Because of its superior soft-tissue contrast and multiplanar capabilities, MRI may be helpful in the detection of CSF leak from a skull base fracture. High resolution heavily T2-weighted images are useful in the evaluation of the olfactory nerve and for potential CSF leaks.
Imaging of Facial Trauma Following Primary Survey. Arteriography Cervicocerebral Angiography of the head and neck may logically follow identification of specific bony or soft tissue injuries but is not useful as the initial imaging modality to identify frontal bone injury. Angiography is used as a problem-solving Imaging of Facial Trauma Following Primary Survey 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]. addresses the role of imaging in the setting of head trauma. CT with IV contrast does not aid in detection of head injury. MRI Maxillofacial There is no relevant literature to support the use of MRI of the face in the initial imaging evaluation of suspected midface injury. However, in patients with cranial nerve deficits not explained or incompletely characterized by CT, MRI can be a useful supplement [31]. In particular, some Le Fort II injuries can disrupt the infraorbital nerve (V2), leading to anesthesia of the upper teeth, gingiva, upper lip, and lateral aspects of the nose [15,32,80]. Zygomatic maxillary complex fractures are often associated with infraorbital nerve (V2) deficits as well [4,79]. In naso-orbital- ethmoid fractures, olfactory nerve injury often occurs. Because of its superior soft-tissue contrast and multiplanar capabilities, MRI may be helpful in the detection of CSF leak from a skull base fracture. High resolution heavily T2-weighted images are useful in the evaluation of the olfactory nerve and for potential CSF leaks.