MRI aids in diagnosing the contents that have herniated through a defect in skull base injuries [49]. These skull base injuries can occur in naso-orbital-ethmoid fractures [31]. 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. Imaging of Facial Trauma Following Primary Survey associated cervical spine injuries [19]. Radiography Paranasal Sinuses For injuries of the midface, CT has largely replaced radiographs [15,30]. The limitations with radiographs are primarily related to inaccuracies, especially with small or fine structures, associated with the superimposition of adjacent anatomic structures and the lack of technical skill resulting from disuse and a lack of training [2]. In one study, radiologists missed 12% of maxillofacial fractures on radiographs compared with CT [81]. When combined with an appropriate physical examination, the Waters, Caldwell, and submentovertex views can provide sufficient information to verify the clinical diagnosis of a zygomaticomaxillary complex fracture. Still, both patient positioning and technological experience are essential [15]. Radiographs may be useful in identifying and determining the location of foreign bodies in the maxillofacial region [50]. High-velocity maxillofacial trauma and penetrating neck trauma are the most common causes of traumatic vascular injuries. Identification and treatment of these injuries should be swift because irreversible neurologic damage or death may occur. Occult neurovascular injury, carotid-cavernous fistula, or carotid transection can occur with severe facial fractures [62,63]. 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].
Imaging of Facial Trauma Following Primary Survey. MRI aids in diagnosing the contents that have herniated through a defect in skull base injuries [49]. These skull base injuries can occur in naso-orbital-ethmoid fractures [31]. 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. Imaging of Facial Trauma Following Primary Survey associated cervical spine injuries [19]. Radiography Paranasal Sinuses For injuries of the midface, CT has largely replaced radiographs [15,30]. The limitations with radiographs are primarily related to inaccuracies, especially with small or fine structures, associated with the superimposition of adjacent anatomic structures and the lack of technical skill resulting from disuse and a lack of training [2]. In one study, radiologists missed 12% of maxillofacial fractures on radiographs compared with CT [81]. When combined with an appropriate physical examination, the Waters, Caldwell, and submentovertex views can provide sufficient information to verify the clinical diagnosis of a zygomaticomaxillary complex fracture. Still, both patient positioning and technological experience are essential [15]. Radiographs may be useful in identifying and determining the location of foreign bodies in the maxillofacial region [50]. High-velocity maxillofacial trauma and penetrating neck trauma are the most common causes of traumatic vascular injuries. Identification and treatment of these injuries should be swift because irreversible neurologic damage or death may occur. Occult neurovascular injury, carotid-cavernous fistula, or carotid transection can occur with severe facial fractures [62,63]. 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].