The cervicocranium: Its radiographic assessment

Acute injuries of the cervicocranium (from the occiput to the second cervic al intervertebral disk) may be radiographically obscure due to minimal disp lacement of fracture fragments, minor alterations of normal anatomic relati onships (occipitoatlantal subluxation), or superimposition of normal skelet al structures. With the nasooropharynx adequately distended with air, the n ormal cervicocranial prevertebral soft-tissue contour is congruent with the anterior cortical margin of the cervicocranium; namely, concave above, con vex anterior to, and concave below the anterior tubercle of C1. Alterations of the normal cervicocranial prevertebral soft-tissue contour due to hemor rhage into the retropharyngeal fascial space from subtle fractures or ligam entous injuries should prompt further assessment of the cervicocranium by m eans of computed tomography (CT). Cervicocranial CT prompted by an abnormal cervicocranial prevertebral soft-tissue contour has yielded a 16% positive injury rate, approximately three times the rate of acute cervical spine in juries reported in the literature.