CT Imaging of facial trauma. The role of different types of reconstruction. Part II – soft tissues

BACKGROUND Injury to facial soft tissues as a complication of skeleton fractures is an important problem among patients with facial trauma. The aim of this work was to assess the value of multiplanar and three-dimensional (3D) reconstruction computed tomography (CT) images obtained by using multi-detector row technology in spiral data acquisition in patients with facial injuries of soft tissue. MATERIAL/METHODS Sixty-seven patients diagnosed with injury to the facial skeleton underwent a CT scan with the use of GE Hispeed Qx/i scanner. For each patient: a two-dimensional (2D) multiplanar reconstruction (MPR), maximum intensity projection (MIP), and 3D volume rendering (VR) were conducted. Post-injury lesions of soft tissues were assessed. During the assessment of the post-injury lesions of soft tissues, the following features were evaluated: Extraocular muscle and fat tissue herniation through fractures in the medial and inferior orbital walls. Fluid in the sinuses and in the nasal cavity. Subcutaneous tissue emphysema. RESULTS For subcutaneous emphysema and sinus fluid imaging, both the axial and the 2D image reconstruction proved comparably effective. However, 2D reconstructions were superior to transverse plane images with regard to herniations into fractures of the inferior orbital wall. 3D reconstruction has no importance in diagnosing soft tissue injuries. CONCLUSIONS Multiplanar CT reconstructions increase the effectiveness of imaging of orbital tissue herniations, especially in case of fractures in the inferior orbital wall. In suspected soft tissue herniations, as well as prior to surgical treatment, spiral CT with 2D multiplanar reconstructions should be the method of choice.