Abstract
Trauma to the facial area accounts for a significant number of admissions to the emergency department. Diagnostic imaging is almost always required, and is critical in determining patient management. Multi‐detector computed tomography (MDCT) appears consistently in the literature as the gold‐standard imaging modality for facial bones, but results in a high radiation dose to the patient. This makes the application and advancement of dose reduction and dose optimisation methods vital. This narrative review presents a critical analysis of the literature concerning diagnostic imaging of facial bone trauma, with an emphasis on dose reduction methods for MDCT. Databases including Pubmed, Medline, Web of Science and Scopus were used to investigate this topic, with the key words: facial bone trauma, computed tomography (CT) imaging and dose reduction. Exclusion criteria included studies on nasal bone fracturing, dental imaging, elective surgeries and paediatric imaging. The literature shows overwhelming support for MDCT, given its accuracy, efficiency and ease of operation. Noise reducing reconstruction algorithms show promise as a successful method of dose reduction in facial bone imaging. Investigations of more innovative techniques also appear within the literature, including diagnostic cone‐beam CT (CBCT), intraoperative CBCT and dual‐source CT (DSCT), but further research is required to confirm their clinical value.
Highlights
Diagnostic imaging plays a major role in the management of trauma patients
Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology
multi-detector computed tomography (CT) (MDCT) is promoted as the gold-standard imaging modality for facial trauma, finding unparalleled support within the current literature
Summary
Diagnostic imaging plays a major role in the management of trauma patients. Facial trauma is associated with a high level of morbidity and mortality. This can be due to compromise of the intricate bony structure or vasculature, or it can be attributed to the effects of concomitant pathology and complications, where most patients are polytrauma cases.[5–7,10–12,76]. All facial bone traumas are initially treated as a medical emergency and there is a demand for timely diagnosis. Subsequent to a primary examination, diagnostic imaging is requested to assess the extent of damage.[1,6,12,13]. Multi-detector CT (MDCT) is presented as the gold-standard imaging modality for the diagnosis and management of complex facial trauma in adult patients.[1,4,9,11,15–19,21–27]. Subsequent to a primary examination, diagnostic imaging is requested to assess the extent of damage.[1,6,12,13] Within the current literature, multi-detector CT (MDCT) is presented as the gold-standard imaging modality for the diagnosis and management of complex facial trauma in adult patients.[1,4,9,11,15–19,21–27] MDCT has superseded the use of plain radiography as first-line imaging because of the greater diagnostic accuracy, the speed of image acquisition and the capacity to scan polytrauma patients or patients with a reduced Glasgow Coma Scale.[1,6,11,16–19,21–27,55,58]
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