CT of the Head for Jaw Pain and Swelling
A CT of the head is not recommended as the initial imaging modality for evaluating jaw pain and swelling; instead, a dedicated maxillofacial CT is the preferred imaging study for this clinical presentation. 1
Appropriate Imaging Selection for Jaw Pain
Maxillofacial CT as First-Line Imaging
- Multidetector CT (MDCT) of the maxillofacial region is the preferred initial imaging modality for evaluating jaw pain and swelling as it offers superior delineation of osseous and soft-tissue structures 1
- CT provides high image resolution with thin-section acquisitions, allowing for detection of subtle nondisplaced fractures and other pathology of the facial skeleton 1
- Maxillofacial CT is nearly 100% sensitive with improved interobserver agreement for detecting fractures and other bony abnormalities of the mandible and maxilla 1
Limitations of Head CT for Jaw Evaluation
- Head CT alone is not useful as the initial imaging modality to identify jaw pathology, as it often only partially images fractures or other abnormalities of the midface and mandible 1
- While a head CT alone can detect up to 95% of facial fractures in geriatric maxillofacial trauma patients, a dedicated maxillofacial CT is still recommended for complete evaluation 1
- Standard head CT protocols are not optimized for evaluating the complex bony structures of the jaw 1, 2
Clinical Considerations for Imaging Selection
Advantages of Dedicated Maxillofacial CT
- Maxillofacial CT offers multiplanar and 3-D image reconstructions, allowing for better characterization of complex pathology 1
- CT is superior to radiography for evaluation of mandibular abnormalities, particularly for posterior mandibular fractures and subtle condyle fractures 1
- Dedicated dental CT reformatting programs can provide panoramic and cross-sectional views that optimize visualization of jaw structures while projecting streak artifacts from dental restorations over the crowns of teeth rather than bone 2
When Head CT May Be Appropriate
- Head CT may logically follow identification of specific bony or soft-tissue injuries but should not be the initial imaging modality 1
- In cases where there is concern for concomitant intracranial injury (such as with trauma), a head CT may be performed in addition to maxillofacial CT 1
- For patients with jaw pain and suspected neurological involvement, both imaging studies may be needed, but maxillofacial CT remains the primary study for evaluating the jaw itself 1
Common Pitfalls to Avoid
- Relying solely on head CT for jaw evaluation may miss important details of jaw pathology due to suboptimal visualization of maxillofacial structures 1
- Failing to obtain dedicated maxillofacial CT with appropriate protocols can lead to inadequate assessment of dental-related inflammatory disease, which is a common cause of jaw pain 3
- Not recognizing that there is poor correlation between condylar changes (as observed on CT images) and pain in temporomandibular joint osteoarthritis, requiring clinical correlation 4
In summary, while head CT has an important role in evaluating intracranial pathology, a dedicated maxillofacial CT with appropriate protocols is the imaging study of choice for evaluating jaw pain and swelling.