Background: Facial trauma is increasingly prevalent, necessitating accurate diagnostic tools like computed tomography (CT). Three-dimensional (3D) reconstruction offers potential advantages over two-dimensional (2D) imaging in evaluating complex fractures.

Objective: This study assessed the efficacy of 3D reconstruction compared to 2D axial CT images in detecting, delineating the extent, and assessing displacement of facial fractures.

Methods: A comparative study was conducted on 60 patients with history of facial trauma at SSIMS & RC, Davangere, from January 2023 to June 2025. CT scans were performed using a GE Optima 128-slice machine, with 2D axial images reconstructed into 3D volume-rendered images. Efficacy was evaluated across five regions (frontal, zygomatic, naso-orbito-ethmoidal, maxillary, mandibular) using a scoring system (1=inferior, 2=similar, 3=superior with rapid assimilation, 4=superior with additional information). Data were analyzed using SPSS software.
Results: Of 60 patients, 93% were male, with a mean age of 34.2 years (SD 15.1). Maxillary fractures were most common (60%). 3D imaging was superior in detecting mandibular fractures (80%, score=3) and assessing displacement in zygomatic fractures (73.9%, score≥3), but inferior for naso-orbito-ethmoidal fracture detection (43.75%, score=1). Statistical significance was noted in mandibular displacement assessment (p=0.02).

Conclusion: 3D reconstruction enhances detection and displacement assessment in specific facial fractures, notably mandibular and zygomatic, but is less effective for thin-boned regions like naso-orbito-ethmoidal fractures.