High-Resolution Maxillofacial Computed Tomography Is Superior to Head Computed Tomography in Determining the Operative Management of Facial Fractures

Talwar, Ankoor A.; Heiman, Adee J.; Kotamarti, Vasanth S.; Bommareddy, Kanthi; Harris, Erin S; Sandberg, Maxwell; Patel, Ashit; Ricci, Joseph A.

doi:10.1016/j.jss.2020.06.060

Cited by 7 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is important to understand that these studies sought to determine the equivalence of head CT to facial CT in recognizing facial injury and were not designed to assess head CT as a screening modality for facial injury. Subsequent studies have clearly shown the superiority of dedicated facial CT in characterizing facial fractures and guiding treatment 4 5…”

Section: Discussionmentioning

confidence: 99%

“…Although dedicated facial CT has a high diagnostic value for detecting injury, it comes at the cost of ionizing radiation exposure and its inherent risk to the developing child 3. Although there is no question that dedicated facial CT is far superior to other imaging modalities in characterizing bony injury to the face,1 4 5 given the exceedingly low rates of injuries requiring intervention, liberal utilization of this modality likely exposes a significant number of children to unnecessary radiation to benefit very few. As many injured children also undergo CT scanning to the head and cervical spine, one must also consider the cumulative effects of repeat exposure to radiosensitive organs in the head and neck.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study

Nguyen

Edwards

Srivatsa³

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundFacial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT is a useful screening tool to identify children requiring dedicated facial CT.MethodsWe conducted a multicenter retrospective review of children aged 18 years and under with blunt facial injury who underwent both CT of the face and head from 2014 through 2018 at five pediatric trauma centers. Penetrating injuries and animal bites were excluded. Imaging and physical examination findings as well as interventions for facial fracture were reviewed. Clinically significant fractures were those requiring an intervention during hospital stay or within 30 days of injury.Results322 children with facial fractures were identified. Head CT was able to identify a facial fracture in 89% (287 of 322) of children with facial fractures seen on dedicated facial CT. Minimally displaced nasal fractures, mandibular fractures, and dental injuries were the most common facial fractures not identified on head CT. Only 2% of the cohort (7 of 322) had facial injuries missed on head CT and required an intervention. All seven had mandibular or alveolar plate injuries with findings on physical examination suggestive of injury.DiscussionIn pediatric blunt trauma, head CT is an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT will usually exclude a clinically significant facial fracture.Level of evidenceIII.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study

Nguyen

Edwards

Srivatsa³

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…CT imaging was subsequently reviewed for the presence of facial fractures, and these were classified as operative facial fractures based on a previously defined framework. 14…”

Section: Methodsmentioning

confidence: 99%

“…stratified by fracture type (Supplementary Digital Content, Table4, http://links.lww.com/SCS/D931). Based on predetermined criteria, these fractures were classified as operative or nonoperative 14. Many patients had multiple fracture types.…”

mentioning

confidence: 99%

Assessment of the Wisconsin Criteria at a Level I Trauma Center

Gray

Kollu

Uppal

et al. 2022

Journal of Craniofacial Surgery

Self Cite

View full text Add to dashboard Cite

: The Wisconsin Criteria was developed for physicians evaluating facial trauma to determine the likelihood of facial fractures. Subsequent studies have not consistently validated these criteria. This study seeks to validate the Wisconsin Criteria and determine its utility in predicting operative facial fractures. Retrospective chart review of the trauma database registry at a Level I Trauma Center was conducted from September 2011 to May 2019. Adult patients who had a complete facial examination by otolaryngology or plastic surgery as well as a head computed tomography scan completed, were included. Fisher exact test was utilized for statistical analysis (P < 0.05) and positive predictive value, and negative predictive value (NPV) were calculated with a 95% confidence interval. After screening, 546 patients met eligibility, 448 had at least 1 finding of the Wisconsin Criteria, and 472 patients had facial fractures. The sensitivity of the Wisconsin Criteria for determining the presence of a facial fracture was 86.23%, the specificity was 44.59%, and the NPV was 33.67% (P < .0001). Malocclusion was the criterion most specific in determining if a facial fracture was present (98.65%), and Glasgow Coma Score < 14 was the least specific (67.57%). The Wisconsin Criteria did aid in the identification of facial fractures in trauma patients with a comparable sensitivity, higher specificity, and much lower NPV than originally described. Further investigation should be done to validate the criteria in other large trauma centers.

show abstract

“…16 A study by Talwar et al showed that formatted maxillofacial CT imaging was 23% more effective than head CT imaging in detecting facial fractures, and also impacted the operative plan despite the fractures being detected on both modalities. 17 Plain film radiography provides limited diagnostic information since fractures are often obscured by anatomical features like developing tooth buds and minimally pneumatized sinuses. 18 CT imaging provides greater diagnostic accuracy, particularly in children where greenstick and nondisplaced fractures may be more common.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Pediatric Facial Fractures

Lim

Hopper

2021

Semin Plast Surg

View full text Add to dashboard Cite

Facial trauma is common in the pediatric population with most cases involving the soft tissue or dentoalveolar structures. Although facial fractures are relatively rare in children compared with adults, they are often associated with severe injury and can cause significant morbidity and disability. Fractures of the pediatric craniomaxillofacial skeleton must be managed with consideration for psychosocial, anatomical, growth and functional differences compared with the adult population. Although conservative management is more common in children, displaced fractures that will not self-correct with compensatory growth require accurate and stable reduction to prevent fixed abnormalities in form and function.

show abstract

High-Resolution Maxillofacial Computed Tomography Is Superior to Head Computed Tomography in Determining the Operative Management of Facial Fractures

Cited by 7 publications

References 16 publications

Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study

Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study

Assessment of the Wisconsin Criteria at a Level I Trauma Center

Pediatric Facial Fractures

Contact Info

Product

Resources

About