High resolution CT with image reformation in maxillofacial pathology.

Twenty-four patients with maxillofacial pathology were examined with computed tomography (CT) using thin (1.5-5.0 mm) sections allowing computer reformation of images in multiple planes. Eight patients also had pluridirectional tomography. The patients included 14 with facial trauma, four with acute paranasal sinus infections, and six with suspected neoplasms. High resolution CT with reformations allowed thorough evaluation of facial trauma. Fracture sites were correctly identified, as were the relation of fragments to vital structures. The form of structural facial alteration was easily assessed, optimizing the presurgical plan for reconstruction. In addition, CT allowed simultaneous evaluation of associated brain injury. In acute infectious processes and neoplasms, CT defined the extent of involvement and directed the type of therapy. In both situations, accurate assessment of bony destruction permitted definitive planning for bony debridement in infection and helped in the differentiation of benign from malignant processes in neoplasia. Density determination also allowed differentiation of neoplastic soft tissue from inspissated mucus within obstructed sinuses. Experience suggests that CT can be the definitive imaging method in the diagnosis of complex maxillofacial pathology when sufficient evaluation is unavailable from plain films. It was superior to thin-section pluridirectional tomography in several instances.