CT (computed tomography) face radiology search pattern

When you start taking call as a radiology resident, a common test you are going to encounter is a maxillofacial CT, or face CT. This is especially true if you are taking call at a level 1 or level 2 trauma center. A lot of times, this is done in conjunction with a head and/or cervical spine CT. This is an extremely common test in the setting of trauma, including assault and car accidents (MVA or MVC). The key in these settings is to rule out a significant fracture or soft tissue injury to the face.

Because there are a lot of structures, it is important to have a useful search pattern. Reconstructions, especially the coronal reconstruction, are key when interpreting CT of the face. These allow you to see key structures that are parallel to the slice plane on axial images. Symmetry is extremely helpful, as the left should match the right. Additionally, making sure all the fat and fascia planes are clean is very useful.

This video will walk you through a step-by-step approach to evaluating a CT of the face. I recommend a pattern where you start with the coronals at the cranial (top) part of the image, and then work your way down. In this way, you can look at the brain, orbits, sinuses, palate, mandible, and so forth, minimizing the risk of missing a significant finding. Then you can repeat the pattern with the axial images. Finally, the sagittal images are a nice troubleshooting tool, especially for the mandible and cervical spine. As you practice, you will find you can move more quickly through your search without necessarily focusing on each individual element for too long.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may be involved with patients with facial injuries and other abnormalities.


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