Clinical Utility of Three-Dimensional Facial Computed Tomography in the Treatment of Nasal Bone Fractures: A New Modality Involving an Air-Bone View with a Volume Rendering Technique

Abstract

To evaluate the utility of three-dimensional (3D) reconstruction when planning the surgical treatment of nasal bone fractures. The axial scan of high-resolution facial bone CT was reconstructed in 3D using the program V-works 4.0 (CyberMed, Seoul, Korea) with a volume and surface rendering technique. For detailed stereoscopic examination of the nasal valve area, an air-bone view with the volume rendering technique was obtained using thresholds for air, cartilage, and bone. In most nasal bone fractures, 2D and 3D CT had similar detection rates. However, to determine the fracture angle and dimpled area, and identify multiple fractures, surgeons can get better information to help with the reduction of the fractured bone from 3D reconstruction images. Additionally, with a septal deformity, this view helps in deciding on the need for septal surgery during nasal reduction. The air view of the nasal passage provides clues to obstruction of the nasal cavity. We could identify the contour and location of the fracture site accurately from 3D CT images. The detection rate of fractures was similar to that of 2D CT. However, 3D CT enabled the accurate determination of the distance and direction of the fractured bony fragment from normal bone structure. Additionally, a stereoscopic image of the fracture site facilitated an understanding of the location and range of reduction. The air-bone view gave more information about the pathological obstruction of the nasal air passage.