Gala Zachary, Bai Di, Halsey Jordan, Ayyala Haripriya, Riddle Kristin, Hohenleitner Julien, Hoppe Ian, Lee Edward, Granick Mark
Rutgers New Jersey Medical School, Newark, NJ.
University of Mississippi Medical Center, Jackson, MS.
Eplasty. 2022 Jun 20;22:e22. eCollection 2022.
In an initial trauma evaluation, computed tomography of the head (CTH) is performed to assess for life-threatening intracranial injury. Given the high incidence of concomitant facial injuries, many facial fractures are diagnosed incidentally during this evaluation. Although maxillofacial CT (CTMF) is widely accepted as the most sensitive method for evaluating facial fractures, it is often excluded from the initial survey. Failure to obtain dedicated imaging can lead to increased costs related to a missed or delayed facial fracture diagnosis. Our study investigates the location and type of missed facial fractures on CTH by reviewing imaging data from patients who presented at a level 1 trauma center and underwent both CTH and CTMF.
A retrospective review of all facial fractures diagnosed at a single institution from 2002 through 2016 was conducted. Inclusion criteria included adults aged 18 years or older who received CTH and then subsequent CTMF. Patients who had either CTH or CTMF only or combined CTH/CTMF were excluded. The facial fractures were further subdivided by location.
There were 501 patients with 1743 total facial fractures. CTH successfully identified 788 (45.21%) fractures, versus 1743 (100%) for CTMF. The most common fractures, in both cohorts, were nasal bone (15.7%) and orbital floor (12.8%) fractures. Using CTMF to identify missed fractures on CTH, significant differences were noted in the following locations: anterior table frontal sinus, medial/lateral pterygoid, maxillary sinus, lateral orbital wall, zygomatic arch, palate, and all types of mandible fractures excluding the mandibular condyle.
CTH for initial trauma evaluation often misses facial fractures. CTH alone was only sufficient in detecting posterior frontal sinus, orbital (excluding lateral wall), and mandibular condyle fractures. In patients with suspected facial injury, dedicated imaging should be performed to detect the location and extent of injury because CTH inadequately identifies most facial fractures.
在初次创伤评估中，会进行头部计算机断层扫描（CTH）以评估危及生命的颅内损伤。鉴于面部损伤合并存在的高发生率，许多面部骨折在该评估过程中被偶然诊断出来。尽管颌面CT（CTMF）被广泛认为是评估面部骨折最敏感的方法，但它在初始检查中常被排除。未能获得专门的影像检查可能导致因面部骨折诊断遗漏或延迟而增加费用。我们的研究通过回顾在一级创伤中心就诊并接受了CTH和CTMF检查的患者的影像数据，调查了CTH上遗漏的面部骨折的位置和类型。
对2002年至2016年在单一机构诊断的所有面部骨折进行回顾性研究。纳入标准包括18岁及以上接受了CTH检查并随后接受CTMF检查的成年人。仅接受CTH或CTMF检查或同时接受CTH/CTMF检查的患者被排除。面部骨折进一步按位置细分。
共有501例患者，总计1743处面部骨折。CTH成功识别出788处（45.21%）骨折，而CTMF识别出1743处（100%）骨折。在两个队列中，最常见的骨折是鼻骨（15.7%）和眶底（12.8%）骨折。使用CTMF识别CTH上遗漏的骨折时，在以下位置发现了显著差异：额窦前壁、翼内/外肌、上颌窦、眶外侧壁、颧弓、腭部以及除下颌髁突外的所有类型的下颌骨骨折。
用于初始创伤评估的CTH经常遗漏面部骨折。仅CTH足以检测额窦后壁、眼眶（不包括外侧壁）和下颌髁突骨折。对于疑似面部损伤的患者，应进行专门的影像检查以检测损伤的位置和范围，因为CTH不足以识别大多数面部骨折。
