Radiologic assessment of maxillofacial, mandibular, and skull base trauma
Radiologic assessment of maxillofacial, mandibular, and skull base trauma
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DOI：
10.1007/s00330-004-2631-7
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发表时间：
2005-03-01
影响因子：
5.9
通讯作者：
Graetz, K
中科院分区：
文献类型：
--
作者：
Schuknecht, B;Graetz, K
颅颌面损伤影响了相当大比例的创伤患者，无论是孤立的或并发其他严重损伤。与直接撞击导致的颌面部损伤相反，中央颅底和侧颅底（岩骨）骨折通常是由颅骨的侧向或矢状方向力引起的，因此是间接骨折。传统的强大作用，传统的图像在病人孤立创伤的内脏颅正在下降。螺旋多层螺旋CT正逐步取代颌面部创伤的全景X线片、沃茨视图和轴位片，并且除了传统的X线片外，还越来越多地用于对下颌骨创伤进行详细描述和分类。因此，影像学有助于根据位置准确地将下颌骨骨折分为11种牙槽骨骨折、下颌骨固有骨折和髁突骨折，后者又细分为囊内骨折和囊外骨折。在面中部，CT有助于将创伤归因于中央骨折、侧骨折或合并中央外侧骨折。最后一种通常也包括眼眶创伤。CT是显示骨折碎片多样性、脱位和旋转程度或颅底受累的首选成像技术。经蝶骨颅底骨折分为横型和斜型;侧颅底（颞骨）外伤又分为纵型和横型。当颅神经麻痹发生时，需要进行补充MR检查，以识别神经压迫。由于感染、脑震荡或脑疝导致的与眼眶、前颅窝或侧颅底相关的创伤的早期和晚期并发症需要CT来显示并发症的骨性先决条件，并且需要MR来确定邻近的脑和软组织受累。
Cranio-maxillofacial injuries affect a significant proportion of trauma patients either in isolation or concurring with other serious injuries. Contrary to maxillofacial injuries that result from a direct impact, central skull base and lateral skull base (petrous bone) fractures usually are caused by a lateral or sagittal directed force to the skull and therefore are indirect fractures. The traditional strong role of conventional images in patients with isolated trauma to the viscerocranium is decreasing. Spiral multislice CT is progressively replacing the panoramic radiograph, Waters view, and axial films for maxillofacial trauma, and is increasingly being performed in addition to conventional films to detail and classify trauma to the mandible as well. Imaging thus contributes to accurately categorizing mandibular fractures based on location, into 11 alveolar, mandibular proper, and condylar fractures-the last are subdivided into intracapsular and extracapsular fractures. In the midface, CT facilitates attribution of trauma to the categories central, lateral, or combined centrolateral fractures. The last frequently encompass orbital trauma as well. CT is the imaging technique of choice to display the multiplicity of fragments, the degree of dislocation and rotation, or skull base involvement. Transsphenoid skull base fractures are classified into transverse and oblique types; lateral base (temporal bone) trauma is subdivided into longitudinal and transverse fractures. Supplementary MR examinations are required when a cranial nerve palsy occurs in order to recognize neural compression. Early and late complications of trauma related to the orbit, anterior cranial fossa, or lateral skull base due to infection, brain concussion, or herniation require CT to visualize the osseous prerequisites of complications, and MR to define the adjacent brain and soft tissue involvement.