Facial trauma and 3-D reconstructive imaging: insufficiencies and correctives.

Purpose: To address the clinical relevance of and optimal technique for 3-D CT imaging of facial trauma.
Methods: Bioengineered cadaveric models were developed to enhance the concepts of LeFort. Diverse CT imaging techniques were applied to obtain optimal data sets for processing on various 3-D workstations. The fidelity of the 3-D reconstructions was determined by comparison with photographs of the cadaveric models. Optimized 3-D images were then used in conjunction with the initial 2-D data sets to assess whether additional accuracy was contributed by the 3-D images in the evaluation of modeled facial fractures.
Results: Image definition was heavily dependent upon the specific 3-D reconstruction algorithm and the processor utilized. Orbital fractures were best imaged when 1- to 1.5-mm coronal sections were processed on an advanced 3-D workstation. The 3-D CT images resulted in additional accuracy in the 2-D CT evaluation of facial fractures in 29% of trials.
Conclusions: We believe that bioengineered models of facial trauma--matched with appropriate CT scanning parameters--facilitate graphically reliable 3-D reconstructive imaging. 3-D reconstructions can improve accuracy in the 2-D CT evaluation of facial trauma.