Imaging of maxillofacial and skull base trauma

Brain and cervical spine imaging is often appropriate in patients with suspected high energy facial or skull base fractures. A systematic approach to plain radiograph analysis is required to screen patients for significant midfacial fractures and CT is not required for uncomplicated fractures. CT rather than plain films is the imaging of choice for suspected craniofacial or skull base fractures. Ultrasound, MRI, angiography and other radiological techniques have a role in the evaluation of soft tissue complications of facial and skull base trauma. It is useful to approach facial and skull base fractures using an anatomical framework comprising mandibular, central/lateral midface, orbital, craniofacial, middle skull base and temporal bone fractures. Neurovascular damage and dural injury leading to cerebrospinal fluid leak and meningitis are key complications of skull base fractures. This review will provide an overview of imaging modalities and protocols used in evaluation of facial and skull base trauma. Typical fracture patterns together with associated soft tissue injuries and complications will be described using an anatomical classification as a framework.