Fig. 12

a Coronal reformatted MDCTA image of a 16-year-old man who sustained a gunshot injury to the right superior zone 2. There is a large haematoma in the right submandibular region, extending medially into the ipsilateral sublingual space and oral cavity, as well as laterally into the supero-lateral facial and buccal soft tissues. The comminuted fracture of the affected posterior aspect of the body of the right hemimandible has yielded numerous fracture fragments which have potentiated soft tissue damage. Because of marked haematoma and haemorrhagic debris affecting the oral cavity and oropharynx, emergency per-oral endotracheal intubation could not be performed and the patient has emergency cricothyroidotomy cannulation in situ. b Axial MDCTA image of the same patient as in a. The extensive soft tissue haematoma and oedematous swelling of the right oral cavity, oropharynx, sublingual space, submandibular space and facial region is evident as well as the in-driven comminuted bone fragments arising from the right hemimandible. Bilateral soft tissue emphysema is present. Note the absence of per-oral endotracheal intubation. c Three-dimensional VRT of the mandible demonstrating the relatively focal comminution of the right hemimandible caused by bullet impact and the resultant dispersal of in-driven bone fracture fragments. Three-dimensional volume-rendered images can be particularly helpful to the maxillofacial surgeon managing such injuries and also in assisting criminal police investigations and court presentations