Foreign Bodies in the Maxillofacial Region: Assessment With Multidetector Computed Tomography Alfonso Reginelli, MD, PhD,* Mario Santagata, MD, PhD, † Fabrizio Urraro, MD, * Francesco Somma, MD, * Andrea Izzo, MD, * Salvatore Cappabianca, MD,* and Antonio Rotondo, MD* Maxillofacial region is an anatomically complex area, representing a crossroads of different systems and apparatus. It is defined as the anatomical region lying on the facial skeleton from the inferior outline of maxilla up to an ideal plane passing through the skull base and the inion point, posteriorly. In this area, the digestive and respiratory systems connect to themselves and open in the mouth and sino-nasal cavities. Even the orbits with the ocular globes and their surrounding tissues lie in the same area. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body due to the “pivotal role” of the face in human relations. Moreover, the external openings of respiratory and digestive systems and the orbital cavities represent an easy way in for foreign bodies (FBs). Based on the access paths, it is possible to distinguish ingested, inhaled, penetrating, and iatrogenic (owing to surgery) FBs. FB may stop in oral and ocular cavities, or proceed deeply, reaching the surrounding soft tissues, the facial bones, or other cavities such as sino-nasal region, mouth, orbits, and further spaces of the head and neck region, like infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FBs accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection. Semin Ultrasound CT MRI 36:2-7 C 2014 Published by Elsevier Inc. Introduction M axillofacial region is an anatomically complex district, representing a complex crossroads of different systems and apparatus. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body owing to the “pivotal role” of the face in human relations. Furthermore, in this area lie the external openings of the respiratory and digestive systems and the orbital cavities, which represent other ways through which foreign bodies (FBs) can penetrate both in the same cavities and across them in deep spaces of maxillofacial area. 1-3 All external objects located in the human body are usually considered as FBs. They can be found not only in oral, nasal, or ocular cavities but also in the surrounding soft tissues, in the facial bones, and in other cavities of head and neck region, such as infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FB accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection. Many emergency calls describe different accident scenarios with FB penetration, especially in case of motor vehicle accident where broken glasses, metal slivers, or rubbles may deeply penetrate the maxillofacial region via skin. The question is what is the role of imaging in patients with facial FB. The answer is that imaging is crucial to identify quickly the penetrating FB (PFB) and all the related pathologies, especially to rapidly address the patients with the correct therapy. Moreover, the complex anatomy of head and neck region and the different characteristics of the FB and its location require different diagnostic protocols. 2 http://dx.doi.org/10.1053/j.sult.2014.10.009 0887-2171/& 2014 Published by Elsevier Inc. *Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy. †Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy. Address reprint requests to Alfonso Reginelli, MD, Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Piazza Miraglia 12, Naples 80138, Italy. E-mail: alfonso.reginelli@unina2.it