Imaging Studies
Order plain films as dictated by the physical examination findings.
Because of the complexity of these injuries, computed tomography (CT) imaging studies yield more accurate information related to the bony architecture and its disruption by injury than plain films. [12]
CT imaging is an integral component of the diagnosis of midfacial fractures. These patients often have a concomitant head injury and require a head CT scan to examine intracranial structures and exclude hemorrhage. Often, if the results are positive for injury, the CT scan needs to be repeated to look for worsening or resolution of an intracranial process.
Axial CT scans through the maxillofacial region can almost always be obtained while performing the initial head CT scan. See the image below.
Coronal CT scans are often difficult to obtain initially in patients who are still intubated and require cervical spine immobilization. Coronal and sagittal reconstructions can usually be obtained from the initial axial CT scans. See the images below.
Three-dimensional CT imaging and computer-generated models of the facial skeleton can be useful in complex cases. [13, 14] They can aid in visualization and treatment planning of the bony injuries. [15] See the image below.
Three-dimensional reconstruction aids in treatment planning of these complex panfacial fractures.
Diagnostic Procedures
One of the keys to repair or reconstruction of the maxillofacial skeleton is occlusion of the teeth. Dental models can be helpful in assessing the exact position of displaced segments of both the maxilla and mandible attached to teeth. Dental models are useful in the reconstruction of acrylic stents and splints for palatal fractures.
Preinjury photographs of the patient obtained from the family can be helpful in determining the patient's preinjury appearance and the presence of any preexisting maxillofacial problems such as congenital telecanthus, hypertelorism, apertognathia, prognathism, retrognathism, and nasal deviation.
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Coronal view of patient with panfacial fractures from facial trauma.
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Close-up view of left zygomatic comminution.
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Coronal view demonstrating cant of maxilla and mandible.
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Axial view demonstrating increased zygomatic width.
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Three-dimensional reconstruction aids in treatment planning of these complex panfacial fractures.
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Large stellate upper lip laceration demonstrating comminution of anterior maxilla.
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Traumatic telecanthus secondary to nasoorbitoethmoid fracture. Intercanthal distance is 39 mm.
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Intermaxillary fixation in place. Note comminution of mandible.
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Coronal approach used to access mid face.
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Comminuted zygomatic arch.
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Coronal access to nasal and medial orbital components.
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Mandible stabilized with plate-and-screw fixation.
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Fixation of zygoma and zygomatic arch.
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Fixation of nasoorbitoethmoid component.
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Maxillary fixation at the level of the zygomaticomaxillary buttress and the piriform rim.
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Postoperative coronal CT scan image.
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Postoperative axial CT scan image.
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Postoperative view of patient.
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Postoperative frontal view of patient, demonstrating good facial symmetry.
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Postoperative profile view of patient, demonstrating good nasal dorsal and zygomatic anterior-posterior projection.
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Postoperative view of patient, demonstrating normal intercanthal distance (33 mm) after resuspension of the medial canthal ligament and fixation of the nasoorbitoethmoid component.
