CT - The Workhorse Head and Neck Imaging Modality

Abstract

CT remains the workhorse of imaging in the head and neck due to its speed, accessibility and high-spatial resolution. New advances in CT imaging pertaining to dual energy CT and cone beam CT also have specific uses in patient assessment; the latter in particular allows low dose scanning of the maxillofacial skeleton, particularly in dental assessment. Limitations remain, namely relative poor soft tissue contrast resolution and radiation exposure. The main indications for CT in the emergency or acute setting are trauma and infection. High resolution, bone-windowed CT images are particularly useful for identifying subtle fractures and allows for the rendering of 3D reconstruction models as useful adjuncts in fracture characterisation. Assessment of infection with CT can be used in the neck, orbit, sinuses and ears. This requires IV contrast to distinguish drainable fluid collections from non-suppurative diffuse inflammatory change. A major benefit of CT includes the availability of high-resolution images for assessing the fine bony detail of the middle ear clefts, orbit and sinuses. It also plays a vital role in assessing for complications either intracranially or within the mediastinum for deep neck infections.