Imaging Recommendations for Facial Injury from Falls

Primary Imaging Recommendations

The American College of Radiology recommends CT maxillofacial without contrast as the first-line imaging for patients with facial injury from a fall, with complementary CT head imaging when intracranial injury is suspected 1, 2
CT maxillofacial without contrast provides superior delineation of osseous and soft-tissue structures with high resolution that can detect subtle nondisplaced fractures of the facial skeleton 3
CT maxillofacial allows for multiplanar and 3D image reconstructions, which are critical for characterizing complex fractures and surgical planning 3
Three-dimensional reformatted images significantly improve surgeon confidence compared to axial CT images alone 4

Frontal bone fractures often result from high-energy blunt trauma, including falls, and CT head is complementary to maxillofacial CT for complete characterization of injury 2, 3
Displaced posterior table fractures may indicate disruption of the underlying dura 2

The American College of Radiology suggests that initial trauma series radiographs should be obtained in major trauma cases before proceeding to CT imaging to evaluate for immediately life-threatening conditions and guide further imaging 4

The American College of Radiology recommends an imaging algorithm that includes initial stabilization, primary imaging with CT maxillofacial without contrast, complementary imaging with CT head without contrast if there is suspicion of intracranial injury, and advanced reconstruction with multiplanar and 3D reconstructions to better characterize fractures and aid surgical planning 2, 3, 4, 5