Comparing the Utility of Head and Facial Computed Tomography (CT) Scans in Identifying Operative Facial Fractures
Joseph A. Ricci, MD, Bao N. Tran, MD, Qing Z. Ruan, MD, Dhruv Singhal, MD, Bernard T. Lee, MD, MBA, MPH.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
BACKGROUND: Computed Tomography (CT) scans have demonstrated utility in identifying facial fractures in trauma patients. However, dedicated facial scans have come under scrutiny compared to traditional head scans for higher radiation doses associated with the higher number of cuts acquired. To date, no study has evaluated the differences in clinical findings seen on head and face CT scans among facial trauma patients to determine if head scans alone are sufficient, or whether dedicated facial scans are required to identify fractures.
METHODS: All operative facial trauma over a 16 year period (1998 - 2013) at a single institution was reviewed. Patients were categorized based on the imaging modality (head or face scan) used to evaluate their facial fractures, excluding those receiving a single imaging study. Fracture patterns seen were categorized and patients receiving both scan types were grouped based on whether the results were identical. Demographic information was compared between the groups. Further analysis was performed for the group with non-identical results to determine the difference in the type and quantity of fractures captured by each scan.
RESULTS: A total of 307 patients were identified who underwent operative repair of traumatic facial fractures and received both face and head CT scans. 106 patients (35%) had findings which differed between the scans, while 201 patients (65%) had identical findings in each scan. No difference between the groups was observed with respect to age, length of hospital stay, gender, or insurance status. No difference was observed with most mechanisms of injury, except motorcycle accidents. For the 106 patients with differing results between the scans, the facial CT scans identified a clinically and statistically significant 40.6% more nasal fractures, 33% more midface fractures, 28.3% more zygoma fractures, 4.7% more frontal sinus fractures and 36.8% more orbital fracture - all of which were operative and would have been missed by standard head CT scan. In aggregate, a total of 151 fractures would have been missed in these patients by head scan alone.
CONCLUSIONS: A significant number of operative facial fractures were identified on dedicated facial imaging, when compared to standard head CT scan in about one third of patients. Dedicated facial CT scans should be strongly considered for patients with a suspicion for facial trauma by history and physical exam.
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