Sophisticated CT in complex maxillofacial trauma.

Conventional radiology and selective complex-motion tomography suffice for the diagnosis of isolated facial fractures. Complex facial fractures, however, require a more directed diagnostic approach, utilizing the imaging potential of computed tomography (CT). In the acutely injured but stable patient, unenhanced axial CT (preview-monitored under clinical orientation) provides the most effective, safe, reasonably rapid diagnostic examination. Direct coronal CT can also be utilized. The brain is studied by contiguous 10 mm slices; the facial skeleton is studied with contiguous 5 mm slices, which permits coronal and sagittal reformations. In suspected cervical spine injury (where direct coronal CT is contraindicated), the axial CT format above will provide essential diagnostic information and allow image reconstruction. The late complications of brain abscess and CSF leak are well imaged by CT; the latter is best assessed (during activity) by preview-controlled CT after intrathecal injection of metrizamide.