Savannah Gelesko, DDS, MDa∗gelesko@ohsu.edu, Michael R. Markiewicz, DDS, MPH, MDa and R. Bryan Bell, DDS, MDbcd,     aDepartment of Oral and Maxillofacial Surgery, Oregon Health and Science University, Mail code: SDOMS, 611 Southwest Campus Drive, Portland, OR 97239, USA; bOral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA; cTrauma Service/Oral and Maxillofacial Surgery Service, Legacy Emanuel Medical Center, 2801 North Gantenbein Avenue, Portland, OR 97227, USA; dOregon Health and Science University, Mail code: SDOMS, 611 Southwest Campus Drive, Portland, OR 97239, USA

∗Corresponding author. Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Mail code: SDOMS, 611 Southwest Campus Drive, Portland, OR 97239.

This article reviews the current standard of care in imaging considerations for the diagnosis and management of craniomaxillofacial trauma. Injury-specific imaging techniques and options for computer-aided surgery as related to craniomaxillofacial trauma are reviewed, including preoperative planning, intraoperative navigation, and intraoperative computed tomography. Specific imaging considerations by anatomic region include frontal sinus fractures, temporal bone fractures, midfacial fractures, mandible fractures, laryngotracheal injuries, and vascular injuries. Imaging considerations in the pediatric trauma patient are also discussed. Responsible postoperative imaging as it relates to facial trauma management and outcomes assessment is reviewed.

Keywords

Maxillofacial trauma • Computer planning • Navigation • Computer-aided surgery • Facial fracture

Key points

Introduction

The past century has seen a dramatic change in the type, quality, and method of diagnostic imaging techniques used for craniomaxillofacial traumatic injuries. This article systematically reviews the current standard of care in imaging considerations for the diagnosis and management of craniomaxillofacial trauma. In addition, injury-specific imaging techniques and options for computer-aided surgery as related to craniomaxillofacial trauma are reviewed, including preoperative planning, intraoperative navigation, and intraoperative computed tomography (CT) scanning. Specific imaging considerations by anatomic region include frontal sinus fractures, temporal bone fractures, midfacial fractures, mandible fractures, laryngotracheal injuries, and vascular injuries. Imaging considerations in the pediatric trauma patient are also discussed. Responsible postoperative imaging as it relates to facial trauma management and outcomes assessment is reviewed.

Computer-aided surgery

Virtual, or computer-aided, surgery encompasses 3 forms of computer-assistance for the maxillofacial surgeon: (1) presurgical planning, (2) intraoperative navigation, and (3) intraoperative CT scanning.

Virtual surgery can be divided into 4 broad phases: (1) data acquisition phase, (2) planning phase, (3) surgical phase, and (4) assessment phase. These phases are modified based on which maxillofacial procedures are being performed. In this article, each phase is reviewed with regard to the treatment of maxillofacial trauma. A thorough discussion on implementing virtual surgery into practice with a step-by-step case review of a panfacial trauma case has recently been described by our institution.1