From the Guidelines
For facial trauma from a fall, a CT scan is the preferred imaging modality over an X-ray due to its superior visualization of complex facial structures and ability to detect subtle fractures. This recommendation is based on the most recent and highest quality study available, which emphasizes the usefulness of MDCT in diagnosing maxillofacial injuries 1. CT scans offer superb delineation of osseous and soft-tissue structures, allowing for the detection of subtle nondisplaced fractures of the facial skeleton.
The advantages of CT scans in this context include:
- High image resolution with thin-section acquisitions
- Ability to evaluate naso-orbital-ethmoid fractures and determine the degree of comminution of the medial orbital wall
- Essential in determining the zygomaticosphenoid suture status in zygomaticomaxillary complex fractures
- Offers multiplanar and 3-D image reconstructions for better characterization of complex fractures
- Faster acquisition time compared to other modalities like radiography and MRI
- Less reliant on patient positioning than radiography
While X-rays may be appropriate for isolated, simple injuries or when CT is unavailable, they often miss important findings, making CT the preferred choice for suspected orbital, maxillofacial, or complex fractures, especially with concerning symptoms like vision changes, malocclusion, or significant swelling 1. CT scans are particularly valuable for surgical planning if intervention is needed, and their benefits outweigh the concerns of radiation exposure in most cases. However, clinical judgment is crucial in balancing diagnostic needs against radiation concerns, especially in children and pregnant women.
From the Research
Imaging Options for Facial Trauma
- Computed Tomography (CT) is considered the gold standard for radiographic evaluation of facial injuries, including those resulting from falls 2.
- CT imaging is useful in diagnosing and managing orbital fractures, which can occur in facial trauma cases 3.
- Multi-detector CT (MDCT) is consistently reported as the gold-standard imaging modality for facial bones, but it results in a high radiation dose to the patient 4.
Comparison with X-ray
- There is no direct comparison between CT and X-ray for facial trauma from falls in the provided studies.
- However, CT imaging is preferred over other imaging techniques due to its accuracy, efficiency, and ease of operation 5, 2.
Specific Considerations
- Multiplanar and three-dimensional (3D) reconstruction CT images can be effective in visualizing fractures, especially in the case of fractures in the inferior orbital wall 5.
- 3D reconstructions can help locate loose bone fragments precisely and assess the degree of displacement 5.
- Signs and symptoms of orbital fractures, such as change in the position of the globe, reduced visual acuity, and subconjunctival haemorrhage, can be useful in predicting these injuries 3.