Although BCVI are uncommon in maxillofacial trauma, exclusion of these injuries is necessary when clinical suspicion is present [21]. The excellent negative predictive value and high sensitivity of the revised Denver criteria make them an excellent screening tool for BCVI [61]. As a risk factor for BCVI, condylar and extracapsular subcondylar fractures should heighten suspicion for concomitant BCVI [9,112]. The data support a force transmission mechanism of injury in addition to direct damage from bony fragments [72,105]. A penetration trajectory, vessel wall hematoma, infiltration of perivascular fat, or foreign bodies <5 mm from a vessel wall should raise suspicion of vascular injury requiring vascular imaging [64,65]. CTA has been recommended over digital subtraction angiography for initial vascular evaluation because of its short acquisition time and low complication rate [21,29]. CTA detects almost all clinically relevant blunt cervical arterial injuries [29,66]. 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. Regarding mandibular injuries, condylar and extracapsular subcondylar fractures should heighten suspicion for concomitant BCVI [9,112]. The data support a force transmission mechanism of injury in addition to direct damage from bony fragments [72,105]. Although MRA is inferior to conventional arteriography, it is considered equivalent to CTA in the setting of BCVI. Similar to CTA, MRA does distinguish almost all clinically significant cervical arterial injuries [29,66]. However, MRA without IV contrast in the neck may be limited because of artifacts and limited resolution. Subtle vascular injuries such as wall irregularity and thickening and mild luminal irregularity can be difficult to detect [67].
Imaging of Facial Trauma Following Primary Survey. Although BCVI are uncommon in maxillofacial trauma, exclusion of these injuries is necessary when clinical suspicion is present [21]. The excellent negative predictive value and high sensitivity of the revised Denver criteria make them an excellent screening tool for BCVI [61]. As a risk factor for BCVI, condylar and extracapsular subcondylar fractures should heighten suspicion for concomitant BCVI [9,112]. The data support a force transmission mechanism of injury in addition to direct damage from bony fragments [72,105]. A penetration trajectory, vessel wall hematoma, infiltration of perivascular fat, or foreign bodies <5 mm from a vessel wall should raise suspicion of vascular injury requiring vascular imaging [64,65]. CTA has been recommended over digital subtraction angiography for initial vascular evaluation because of its short acquisition time and low complication rate [21,29]. CTA detects almost all clinically relevant blunt cervical arterial injuries [29,66]. 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. Regarding mandibular injuries, condylar and extracapsular subcondylar fractures should heighten suspicion for concomitant BCVI [9,112]. The data support a force transmission mechanism of injury in addition to direct damage from bony fragments [72,105]. Although MRA is inferior to conventional arteriography, it is considered equivalent to CTA in the setting of BCVI. Similar to CTA, MRA does distinguish almost all clinically significant cervical arterial injuries [29,66]. However, MRA without IV contrast in the neck may be limited because of artifacts and limited resolution. Subtle vascular injuries such as wall irregularity and thickening and mild luminal irregularity can be difficult to detect [67].