CT Maxillofacial (Facial Bones, Trauma)

Indications

• Facial trauma: nasal, orbital (blow-out), zygomaticomaxillary complex, Le Fort, mandibular, naso-orbito-ethmoid fractures
• Preoperative planning for facial fracture repair

Patient prep

• Maintain C-spine precautions if concurrent trauma
• Remove dentures, glasses, facial jewelry
• Usually no contrast unless soft tissue/vascular injury or infection concern

Contrast

Technique

• Supine, head neutral in holder; gantry/scan plane axial
• Coverage from top of frontal sinus through mandible (include entire mandible if mandibular fracture suspected)
• 120 kV, dose-modulated; sub-mm collimation helical
• Bone (sharp) and soft tissue recon; thin axial 0.625-1 mm
• Multiplanar reformats; 3D volume rendering for surgical planning

Series / Sequences

Key points

• Coronal reformats key for orbital floor/roof and entrapment evaluation
• Include full mandible (TMJ to symphysis) when mandibular fracture suspected; mandible often needs dedicated panoramic-type reformats
• 3D VR helps surgeons characterize displaced ZMC and Le Fort patterns
• Assess for orbital emphysema, herniated fat/muscle, and intraconal injury
• Often combined with non-contrast head CT in trauma

References