Facial Trauma

Population Covered By The Guidance

This pathway provides guidance on the imaging of adult patients with facial trauma/injuries, to aid in diagnosis and management plan.

Lead Researcher: Renqiao Lan

Experts & Contributors: Ravinder Dhillon, Ferry Dharsono, Sudhakar Rao, Bronwyn Peirce, Kieran Kusel and Richard Mendelson

Date reviewed: Feb 2022. Further minor revision to text 2025

Date Published: June 2025

No available images

  • Conventional or high resolution multidetector computed tomography (CT) is the gold standard for the radiographic evaluation of patients with facial trauma

  • Plain films are no longer a routine part of diagnostic imaging of patients with facial trauma

  • Imaging is not indicated for simple nasal fractures

  • Cone beam CT (CBCT) and ultrasonography (US) are emerging imaging modalities in assessing maxillofacial injuries

  • Ultrasonography (US) has shown high sensitivity and specificity in evaluating maxillofacial fractures. However, its use has been mainly limited to nasal and orbital traumas and is not recommended in acute and emergency settings 

Date of literature search: February 2022

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Lo Casto A, Priolo GD, Garufi A, Purpura P, Salerno S, La Tona G, et al. Imaging evaluation of facial complex strut fractures. Semin Ultrasound CT MR. 2012;33(5):396-409. (Review article)
  2.  Bernstein MP. The Imaging of Maxillofacial Trauma 2017. Neuroimaging Clin N Am. 2018;28(3):509-24. (Review article)
  3.  Gómez Roselló E, Quiles Granado AM, Artajona Garcia M, Juanpere Martí S, Laguillo Sala G, Beltrán Mármol B, et al. Facial fractures: classification and highlights for a useful report. Insights Imaging. 2020;11(1):49. (Review article)
  4.  Peeters N, Lemkens P, Leach R, Gemels B, Schepers S, Lemmens W. Facial trauma. B-ent. 2016;Suppl 26(2):1-18. (Review article)
  5.  Hoffmann JF. An Algorithm for the Initial Management of Nasal Trauma. Facial Plast Surg. 2015;31(3):183-93. (Review article)
  6. Salvolini U. Traumatic injuries: imaging of facial injuries. Eur Radiol. 2002;12(6):1253-61. (Review article)
  7.  Chukwulebe S, Hogrefe C. The Diagnosis and Management of Facial Bone Fractures. Emerg Med Clin North Am. 2019;37(1):137-51. (Review article)
  8.  Mehta N, Butala P, Bernstein MP. The imaging of maxillofacial trauma and its pertinence to surgical intervention. Radiol Clin North Am. 2012;50(1):43-57. (Review article)
  9.  Shintaku WH, Venturin JS, Azevedo B, Noujeim M. Applications of cone-beam computed tomography in fractures of the maxillofacial complex. Dent Traumatol. 2009;25(4):358-66. (Review article)
  10.  Ellis E, 3rd. Orbital trauma. Oral Maxillofac Surg Clin North Am. 2012;24(4):629-48. (Review article)
  11.  Gelesko S, Markiewicz MR, Bell RB. Responsible and prudent imaging in the diagnosis and management of facial fractures. Oral Maxillofac Surg Clin North Am. 2013;25(4):545-60. (Review article)
  12.  Sun JK, LeMay DR. Imaging of facial trauma. Neuroimaging Clin N Am. 2002;12(2):295-309. (Review article)
  13.  Caranci F, Cicala D, Cappabianca S, Briganti F, Brunese L, Fonio P. Orbital fractures: role of imaging. Semin Ultrasound CT MR. 2012;33(5):385-91. (Review article)
  14.  Ceallaigh PO, Ekanaykaee K, Beirne CJ, Patton DW. Diagnosis and management of common maxillofacial injuries in the emergency department. Part 4: orbital floor and midface fractures. Emergency medicine journal : EMJ. 2007;24(4):292-3. (Review article)
  15.  Ceallaigh PO, Ekanaykaee K, Beirne CJ, Patton DW. Diagnosis and management of common maxillofacial injuries in the emergency department. Part 3: Orbitozygomatic complex and zygomatic arch fractures. Emerg Med J. 2007;24(2):120-2. (Review article)
  16.  Dreizin D, Nam AJ, Tirada N, Levin MD, Stein DM, Bodanapally UK, et al. Multidetector CT of Mandibular Fractures, Reductions, and Complications: A Clinically Relevant Primer for the Radiologist. Radiographics. 2016;36(5):1539-64. (Review article)
  17.  Eng J, Sivam S. General Overview of the Facial Trauma Evaluation. Facial Plast Surg Clin North Am. 2022;30(1):1-9. (Review article)
  18.  Gohel A, Oda M, Katkar AS, Sakai O. Multidetector Row Computed Tomography in Maxillofacial Imaging. Dent Clin North Am. 2018;62(3):453-65. (Review article)
  19.  Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729-39. (Review article)
  20.  Lynham AJ, Hirst JP, Cosson JA, Chapman PJ, McEniery P. Emergency department management of maxillofacial trauma. Emerg Med Australas. 2004;16(1):7-12. (Review article)
  21.  Meara DJ. Diagnostic Imaging of the Maxillofacial Trauma Patient. Atlas Oral Maxillofac Surg Clin North Am. 2019;27(2):119-26. (Review article)
  22.  Nardi C, Vignoli C, Pietragalla M, Tonelli P, Calistri L, Franchi L, et al. Imaging of mandibular fractures: a pictorial review. Insights Imaging. 2020;11(1):30. (Review article)
  23.  Thelen J, Bhatt AA, Bhatt AA. Acute ocular traumatic imaging: what the radiologist should know [corrected]. Emerg Radiol. 2017;24(5):585-92. (Review article)
  24.  Truong TA. Initial Assessment and Evaluation of Traumatic Facial Injuries. Semin Plast Surg. 2017;31(2):69-72. (Review article)
  25.  Tuckett JW, Lynham A, Lee GA, Perry M, Harrington U. Maxillofacial trauma in the emergency department: a review. Surgeon. 2014;12(2):106-14. (Level I evidence)
  26.  Uzelac A, Gean AD. Orbital and facial fractures. Neuroimaging Clin N Am. 2014;24(3):407-24, vii. (Review article)
  27.  Winegar BA, Murillo H, Tantiwongkosi B. Spectrum of critical imaging findings in complex facial skeletal trauma. Radiographics. 2013;33(1):3-19. (Review article)
  28.  Dreizin D, Nam AJ, Hirsch J, Bernstein MP. New and emerging patient-centered CT imaging and imageguided treatment paradigms for maxillofacial trauma. Emerg Radiol. 2018;25(5):533-45. (Review article)
  29.  Alimohammadi R. Imaging of Dentoalveolar and Jaw Trauma. Radiol Clin North Am. 2018;56(1):105-24. (Review article)
  30.  Ceallaigh PO, Ekanaykaee K, Beirne CJ, Patton DW. Diagnosis and management of common maxillofacial injuries in the emergency department. Part 2: mandibular fractures. Emerg Med J. 2006;23(12):927-8. (Review article)

Pathway User Guide

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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

SYMBOL RRL EFFECTIVE DOSE RANGE
No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv

Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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Trauma