Role of routine nonenhanced head computed tomography scan in excluding orbital, maxillary, or zygomatic fractures secondary to blunt head trauma

Abstract

The purpose of this paper is to determine the necessity of a dedicated facial bone/orbital computed tomography (CT) scan for fracture surveillance in patients who have suffered blunt head trauma and whose routine nonenhanced head CT scan is negative. It is based on a retrospective review of 115 patients presenting to the Emergency Department at a level I trauma center after blunt head trauma. Included patients underwent both a nonenhanced head CT scan and a dedicated facial bone or orbit CT. Standard nonenhanced head CT protocol was followed for each patient as per department protocol. A positive head CT scan is defined to include either an air-fluid level within the paranasal sinuses or fracture of the maxillary, orbital, or zygomatic osseous structures. A negative scan demonstrates none of these findings. Intracranial/parenchymal pathology was not evaluated in this study. Sixty-five of the 115 patients had a negative head CT scan as defined above. Of these 65 patients, none subsequently had a positive facial bone or orbit CT scan. The sensitivity and negative predictive values of a negative routine nonenhanced head CT scan for fracture surveillance are both 100%. In the setting of blunt trauma, a negative nonenhanced head CT scan precludes the need for a dedicated facial bone or orbital CT scan in the evaluation for orbital, maxillary, or zygomatic fractures. This saves the patient unnecessary radiation exposure, health care costs, and time spent in the emergency radiology department.

Violence-related facial trauma: analysis of multidetector computed tomography findings of 727 patients

“…Interestingly, only 19% of 48 patients with a LeFort fracture presented as typical symmetrical, single fractures (Table 2). An orbital or maxillary fracture can be suspected when an air-fluid level is present in the paranasal sinuses; 10,21 injury to the lining of the sinuses results in this free fluid. 10,21 However, 25 patients were found with clear sinuses despite suffering a fracture of a bone adjacent to the sinus wall.…”

Significance of post-traumatic maxillary sinus fluid, or lack of fluid, in a level II trauma population

“…These cases would cause more false negative cases in our cohort, decreasing our calculated sensitivity. A subsequent paper by Lewandowski et al found that in a level I trauma population, a partially visualized air-fluid level Bor fracture of the maxillary, orbital, or zygomatic osseous structures^on a head CT has 100 % sensitivity for certain facial bone fractures [13]. Still as that paper scored direct visualization of a fracture as a true positive exam, it is unclear from that study what the actual performance of a maxillary sinus air-fluid level is for predicting a fracture.…”

Imaging of the Midfacial and Orbital Trauma

“…[46][47][48] Supplementary, we emphasize the possibility of nonenhanced scan protocols in CT that reduce exposure. 49 Skew in bony continuity, instabilities, loss of symmetry, (monocular) hematoma, swelling, pain on palpation, hypoesthesia, absence of pain or numbness, and ability to occlude habitually are the most striking aspects to choose the suitable radiologic modality. 50 Acute and suspended bleeding-especially strictly unilateral epistaxis-can be assumed as a hint for a fracture and is an often overlooked symptom.…”