Ricci Joseph A, Tran Bao Ngoc N, Ruan Qing Z, Lin Samuel J, Singhal Dhruv, Lee Bernard T
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2018 Apr;80(4 Suppl 4):S219-S222. doi: 10.1097/SAP.0000000000001289.
Patients who present for a trauma workup often have a head computed tomography (CT) performed to identify intracranial pathology. Facial fractures are routinely identified in these patients, and further imaging is the norm with dedicated facial CT scans. Additional imaging increases radiation doses; however, it is unclear if additional operative fractures are identified. The aim of this study was to examine differences between these 2 CT imaging modalities.
A retrospective review of all operative facial trauma patients receiving both head and facial scans at a single institution was performed (1999-2012). Identified fracture patterns were compared between the head and facial CT scans of each patient to determine if the results correlated. Demographic information and injury mechanism were compared.
A total of 307 patients receiving both types of CT scan underwent facial fracture repair. In the 106 patients (35%) with differences identified fractures between the scans, 151 additional operative fractures were found through dedicated facial imaging: nasal fractures (58 vs 15; P < 0.001), midface fractures (69 vs 34; P < 0.001), zygoma fractures (51 vs 21; P < 0.001), and orbital fractures (90 vs 51; P < 0.001). No differences in demographics or mechanisms of injury were observed between groups.
Standard head CT scans alone failed to identify a significant number of operative facial fractures compared with facial CT in 35% of patients. Dedicated facial CT scans should be considered for patients with known or suspected facial fractures, even if a head scan has been performed previously.
因创伤接受检查的患者通常会进行头部计算机断层扫描（CT）以确定颅内病变。这些患者中面部骨折常能被常规识别，进一步的影像学检查通常是进行专门的面部CT扫描。额外的影像学检查会增加辐射剂量；然而，尚不清楚是否能识别出更多需要手术治疗的骨折。本研究的目的是检查这两种CT成像方式之间的差异。
对在单一机构接受头部和面部扫描的所有手术治疗的面部创伤患者进行回顾性研究（1999年至2012年）。比较每位患者头部和面部CT扫描所识别的骨折类型，以确定结果是否相关。比较人口统计学信息和损伤机制。
共有307例接受两种CT扫描的患者接受了面部骨折修复。在106例（35%）扫描结果存在差异的骨折患者中，通过专门的面部成像发现了151处额外需要手术治疗的骨折：鼻骨骨折（58处对15处；P<0.001）、面中部骨折（69处对34处；P<0.001）、颧骨骨折（51处对21处；P<0.001）和眼眶骨折（90处对51处；P<0.001）。两组间在人口统计学或损伤机制方面未观察到差异。
与面部CT相比，仅标准头部CT扫描未能在35%的患者中识别出大量需要手术治疗的面部骨折。对于已知或疑似面部骨折的患者，即使之前已进行过头部扫描，也应考虑进行专门的面部CT扫描。
