Shatzkes DR, guest ed. Mukherji SK, consulting ed. Craniofacial Trauma. Elsevier; August 2014. Neuroimaging Clinics of North America; vol. 24, no. 3; pgs. 395–556; $489.00
The August 2014 issue of the Neuroimaging Clinics of North America deals with a practical topic, craniofacial trauma, and clinical situations that neuroradiologists, general radiologists, and ER radiologists deal with on a daily basis. For that reason, this is one of the more important issues of the NICNA.
Edited by Dr. Shatzkes, with 23 contributors, this 160-page book deals with orbital, base of skull, temporal bone, vascular, and pediatric trauma. Additional chapters on optimal CT techniques and surgical perspectives on cranial and facial trauma round out this book.
The initial chapter on techniques, particularly on how to improve image quality while maintaining or decreasing radiation dose, outlines the basic considerations, and shows nice examples of the affect on quality with varying KVPs, displaying 3D reconstructions using cone beam CT and applying iterative reconstructions. This well-written and straightforward 9-page chapter sets the stage for what follows.
The following chapters deal with trauma to specific areas, and highlighted in each are the key items to observe and make sure are mentioned in reports. So, for example, in consideration of orbital and facial fracture 3 things are emphasized: 1) the importance of understanding facial buttresses, 2) directing one’s attention to specific areas such as the nasofrontal duct, and 3) the important considerations of the medical canthal ligament in naso-orbital ethonoidal fractures. While many other fractures discussed are widely known to neuroradiologists, there are subtleties worth reviewing.
The illustrations in the chapter on skull base fractures (26 pages) is worth reviewing because it covers the commonly encountered abnormalities in this area. This chapter also contains good general pictorial displays of the bony anatomy of the skull base; it is always worthwhile to review the basic and critical bony land marks and to refresh oneself as to a number pseudofractures, which can easily be mistaken for fractures in the setting of facial trauma. The authors nicely point out complications of these fractures and describe the imaging pitfalls when assessing the skull base.
Temporal bone trauma can result in overt or subtle imaging findings, and this chapter describes and shows examples of each. Current fracture terminology supplants the older longitudinal vs. transverse fracture terms and the material explains why. The images here are good and the detailed abnormalities can be well appreciated. The authors nicely integrate the treatment of various traumatic lesions with the CT findings—very helpful.
Clinically, vascular lesions may be ignored or not recognized in cases of craniofacial trauma. When, however, there is a suspicion of a trauma-induced vascular lesion, the techniques to demonstrate them must be understood. This chapter explains the variables and shows the typical findings. The images, in particular, are worth reviewing, along with the classification system (Denver) for traumatic vascular injuries.
The material and images in pediatric craniofacial trauma allow one to review not only the typical pediatric injuries but, importantly, those often confusing normal findings in a developing skull base that can mimic fractures.
The book ends with a chapter on surgical perspectives. An appreciation of what is done and why is an important addition to the book.
Overall, this is a solid addition to the NICNA collection. It is a good review and brings out many concepts, both clinically and in imaging, that may not otherwise be totally understood by radiologists. It would be particularly valuable to radiologists/neuroradiologists who spend time reading emergency cases.
