Using these criteria, blunt trauma patients with particular signs and symptoms of BCVI or risk factors for BCVI should undergo cerebrovascular imaging. Le Fort II and Le Fort III fractures are both risk factors for BCVI. Also, the Eastern Association for the Surgery of Trauma currently recommends screening all patients with Le Fort II or III facial fractures for the presence of BCVI [82]. One study based on an analysis of 4,398 patients recommended screening for BCVI in Le Fort I facial fractures [17]. 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]. MRA Head and Neck MRA 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 midface injury. Guidance on the imaging of vascular injuries in 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. Although MRA is inferior to conventional arteriography, it is considered equivalent to CTA in 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. Using these criteria, blunt trauma patients with particular signs and symptoms of BCVI or risk factors for BCVI should undergo cerebrovascular imaging. Le Fort II and Le Fort III fractures are both risk factors for BCVI. Also, the Eastern Association for the Surgery of Trauma currently recommends screening all patients with Le Fort II or III facial fractures for the presence of BCVI [82]. One study based on an analysis of 4,398 patients recommended screening for BCVI in Le Fort I facial fractures [17]. 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]. MRA Head and Neck MRA 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 midface injury. Guidance on the imaging of vascular injuries in 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. Although MRA is inferior to conventional arteriography, it is considered equivalent to CTA in 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].