Huang Li-Kuo, Wang Hsueh Han, Tu Hsi-Feng, Fu Chih-Yuan
Department of Radiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan; Deparment of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Radiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan.
Injury. 2017 Jul;48(7):1417-1422. doi: 10.1016/j.injury.2017.04.046. Epub 2017 Apr 24.
Patients with traumatic brain injury (TBI) may have concomitant facial fractures. While most head injury patients receive head computed tomography (CT) scans for initial evaluation, the objective of our study was to investigate the value of simultaneous facial CT scans in assessing facial fractures in patients with TBI.
From January 1, 2015 to December 31, 2015, 1649 consecutive patients presenting to our emergency department (ED) with a TBI who received CT scans using the protocol for head and facial bones were enrolled. The clinical data and CT images were reviewed via a standardized format.
In our cohort, 200 patients (12.1%) had at least one facial fracture shown on the CT scans. Patients with facial fractures were more likely to have initial loss of consciousness (ILOC; p<0.001), a Glasgow coma scale of 8 or less (p<0.001), moderate or severe degrees of head injury severity scale (p<0.001), positive physical examination findings (p<0.001), and positive CT cranial abnormalities (p<0.001). A total of 166 (83.0%) patients with facial fractures required further facial CT scans instead of conventional head CT scans alone. Surgical intervention was mandatory in 73 (44.0%) of the 166 patients, who more frequently exhibited fractures of the lower third of the face (p<0.001) and orbital fractures (p=0.019).
TBI patients with risk factors may have a higher probability of concomitant facial fractures. Fractures of the lower third of the face and orbit are easily overlooked in routine head CT scans but often require surgical intervention. Therefore, simultaneous head and facial CT scans are suggested in selected TBI patients.
创伤性脑损伤（TBI）患者可能伴有面部骨折。虽然大多数头部受伤患者会接受头部计算机断层扫描（CT）进行初步评估，但我们研究的目的是探讨同步进行面部CT扫描在评估TBI患者面部骨折中的价值。
2015年1月1日至2015年12月31日，连续纳入1649例因TBI到我院急诊科就诊并按照头部和面部骨骼扫描方案接受CT扫描的患者。通过标准化格式回顾临床资料和CT图像。
在我们的队列中，200例患者（12.1%）CT扫描显示至少有一处面部骨折。有面部骨折的患者更可能出现初始意识丧失（ILOC；p<0.001）、格拉斯哥昏迷量表评分8分或更低（p<0.001）、中度或重度头部损伤严重程度量表评分（p<0.001）、体格检查阳性结果（p<0.001）以及CT头颅异常阳性（p<0.001）。总共166例（83.0%）有面部骨折的患者需要进一步进行面部CT扫描，而不是仅进行传统的头部CT扫描。166例患者中有73例（44.0%）必须进行手术干预，这些患者更常出现面部下三分之一骨折（p<0.001）和眼眶骨折（p=0.019）。
有危险因素的TBI患者伴有面部骨折的可能性更高。面部下三分之一和眼眶骨折在常规头部CT扫描中容易被忽视，但通常需要手术干预。因此，建议对部分TBI患者同时进行头部和面部CT扫描。
