Objective To explore the application value of 64-slice spiral CT volume scan and three-dimensional (3D) reconstruction in the diagnosis and treatment of maxillofacial fractures. Methods The clinical data of 69 patients with maxillofacial fractures admitted to Shanghai Fifth People's Hospital from March 2016 to March 2018 were retrospectively analyzed. All patients were diagnosed by surgery, and they were given 64-slice spiral CT scan before surgery. The data were transmitted to the workstation for 3D reconstruction. The distribution of maxillofacial fractures sites was observed, and the detection rates of fractures between CT and 3D reconstruction were compared. The patients were reviewed at 3 months after operation, and the postoperative recovery was observed. Results Among 69 patients with maxillofacial fractures, there were 156 fractures founded by surgery, and 41 cases were with multiple fractures. The maxillary fractures and mandibular fractures were the most common, and the sphenoid bone, brow bone and ethmoid fractures were the least common. The detection rate of CT 3D reconstruction for maxillofacial fracture was higher than that in CT plain scan [96.79% (151/156) vs 84.62% (132/156) (χ2 =13.724, P<0.05). Conclusion Three-dimensional reconstruction of 64-slice spiral CT has a high diagnostic value for maxillofacial fractures, and it detection rate is higher than that of CT plain scan, and can accurately evaluate the postoperative internal fixation and recovery.