Also, it is less reliant on patient positioning than radiography. CT is typically the first-line of imaging to identify penetrating foreign bodies and the subsequent determination of their trajectory and extent of the injury [47,48]. A novel volume visualization tool, cinematic rendering, is a promising technique to illustrate mandibular fractures [41]. CT with IV contrast does not aid in detection of facial injury. MRI Maxillofacial In rare instances, some reports have advocated for MRI in the acute setting to diagnose temporomandibular joint disc morphology and position in certain condylar fractures [2,104,105]. Also, in patients with cranial nerve deficits not explained or incompletely characterized by CT, MRI can be a useful supplement [31]. In particular, fractures through the mandibular canal may damage the inferior alveolar nerve as it travels through the mandibular canal. Damage to the inferior alveolar nerve may result in anesthesia of the ipsilateral lower lip, chin, anterior tongue, and mandibular teeth. Also, MRI is superior to CT for detecting small pieces of asphalt, which could occur as facial foreign bodies [50]. MRI with IV contrast is not useful in detection of facial injury. Radiography Mandible In patients with a low clinical suspicion of injury, an OPG (panoramic radiograph) or mandibular series consisting of Towne, bilateral lateral oblique, and lateral views may be obtained to evaluate for mandibular fractures. With a sensitivity of 86% to 92%, OPG has better sensitivity for detecting simple mandibular fractures than a standard 4- view mandibular imaging series [31,101,102,106]. Specifically, an OPG demonstrated a sensitivity of 92% in detecting a mandibular fracture in contrast with 66% with a mandibular series [106].
Imaging of Facial Trauma Following Primary Survey. Also, it is less reliant on patient positioning than radiography. CT is typically the first-line of imaging to identify penetrating foreign bodies and the subsequent determination of their trajectory and extent of the injury [47,48]. A novel volume visualization tool, cinematic rendering, is a promising technique to illustrate mandibular fractures [41]. CT with IV contrast does not aid in detection of facial injury. MRI Maxillofacial In rare instances, some reports have advocated for MRI in the acute setting to diagnose temporomandibular joint disc morphology and position in certain condylar fractures [2,104,105]. Also, in patients with cranial nerve deficits not explained or incompletely characterized by CT, MRI can be a useful supplement [31]. In particular, fractures through the mandibular canal may damage the inferior alveolar nerve as it travels through the mandibular canal. Damage to the inferior alveolar nerve may result in anesthesia of the ipsilateral lower lip, chin, anterior tongue, and mandibular teeth. Also, MRI is superior to CT for detecting small pieces of asphalt, which could occur as facial foreign bodies [50]. MRI with IV contrast is not useful in detection of facial injury. Radiography Mandible In patients with a low clinical suspicion of injury, an OPG (panoramic radiograph) or mandibular series consisting of Towne, bilateral lateral oblique, and lateral views may be obtained to evaluate for mandibular fractures. With a sensitivity of 86% to 92%, OPG has better sensitivity for detecting simple mandibular fractures than a standard 4- view mandibular imaging series [31,101,102,106]. Specifically, an OPG demonstrated a sensitivity of 92% in detecting a mandibular fracture in contrast with 66% with a mandibular series [106].