Because of the superimposition of bony structure on plain radiographs, interpretation of facial injury can be intimidating and inaccurate. Helical CT with two- and three-dimensional reformations greatly simplifies interpretation, is highly accurate for diagnosing fractures and soft tissue injuries, and is more accurate than plain radiographs for many fractures. Helical CT is also accurate in assessing which areas of facial injury are stable or unstable for planning corrective surgery and in determining the degree of displacement or rotation of major bony fragments. Helical CT has been shown to be faster and to produce planar and three-dimensional reformations with less motion artifact than conventional CT in the assessment of facial trauma. The diagnostic value of three-dimensional images has been studied, and three-dimensional images have been shown to add significantly in the evaluation of severe facial trauma in 29% of patients. Three-dimensional imaging appears superior in localization of complex fractures involving multiple planes, in perception of fracture displacement, and in assessment of facial symmetry. Three-dimensional imaging has been used for fabrication of bone grafts in complex facial restorations. Although some mandible fractures may be adequately assessed by plain radiographs, the sagittal splitting fracture of the condyle is seen only with CT and detection of anterior displacement of the condyle is superior with CT. It has been shown that the extent of comminution of mandibular fractures and the location of stable bicortical bone for fixation should be assess with CT because this information is often not evident from plain radiographs or a panorex view. In the intubated blunt trauma patient, over half of facial fractures are not suspected clinically.