High-resolution CT analysis of facial struts in trauma: 2. Osseous and soft-tissue complications

In six cadavers, high-resolution thin-section computed tomography (CT) was used to evaluate the sequelae of experimentally produced facial trauma. As confirmed by pluridirectional tomography, CT was an effective imaging method for the detection and classification of facial fractures. The ability of CT to simultaneously depict both osseous and soft-tissue structures expands the role that diagnostic radiology can play in the evaluation of the traumatized face. A method of evaluation is presented in which the face is geometrically conceptualized as a series of triplanar (horizontal, sagittal, and coronal) osseous struts. Sequential, systematic assessment of each strut for fracture and its adjacent soft tissue for injury can facilitate evaluation of the traumatized face. Using this approach the osseous and soft-tissue complications arising from experimentally produced trauma are reviewed and illustrated with CT. Examples of potential soft-tissue complications that may occur with fractures of the horizontal group of struts include disruption of the dura matter at the cribiform plate, involvement of the structures of the anterior cranial fossa, injury to the optic nerve, and involvement of the superior and inferior groups of extraocular muscles. Injury to the nasolacrimal duct, maxillary sinus ostium, medial and lateral rectus muscles, or the soft-tissue structures in the superior and inferior orbital fissures may arise from disruption of the sagittal struts. Fractures of the coronal struts may involve the frontal sinus, anterior cranial fossa, lacrimal gland, nasofrontal duct, lacrimal sac, or the soft tissues of the pterygopalatine fossa.