Value of three-dimensional computed tomography in craniomaxillofacial surgery

Three-dimensional (3-D) computed tomographic (CT) scans of 72 adult patients were evaluated by two observers in a blinded fashion by comparing the 3-D images with the two-dimensional (axial and coronal) CT scans. With 3-D CT, the observers found improved visualization of facial anatomy in certain patients (i.e., asymmetries of the whole face and skull, large defects of the midface and skull vault, and fractures with major dislocation). In these defects, the information can be assimilated more rapidly. The documentation of effects of cranial surgery on craniofacial growth and resorption after reconstruction with autologous material can also be evaluated more accurately. Because higher levels of radiation are used, 3-D CT protocols are less indicated in patients with minor dislocation of fractures, tumors, and inflammations. Three-dimensional CT images in these patients are of little help and can mislead the surgeon. Further improvements in hardware and software will allow more accurate surgical planning by performing interactive surgery or by producing precise models.