The role of computed tomographic scanning in the management of facial trauma

Objective: To determine how often the management of patients with blunt facial trauma was altered by plain roentgenograms or facial computed tomographic (CT) scans compared with findings from physical examination. Method: This is a retrospective review of consecutive patients admitted with blunt facial trauma and evaluated by the Division of Plastic Surgery from 1988 to 1994, Physical findings were correlated with fractures detected by plain roentgenograms or facial CT reports, Treatment plans were reviewed to determine how management was altered by radiographic studies, Hospital charges were determined for the various studies. Results: One hundred thirty-seven records were reviewed. Thirty patients had only lacerations and no fractures, Two hundred forty-three fractures were detected on physical examination among 98 patients (91.5%). One hundred two patients (95.3%) had facial CT scans and 85 patients (79.4%) had facial plain films obtained. Radiographic findings identified a total of 255 fractures among 107 patients (78%), Ninety-four patients (87.9%) required operative interventions for these facial fractures. Only 19 patients (17.8%) had management altered by radiographic findings: CT scan (7 patients) and plain films (12 patients). The management of 88 facial fractures (34.5%) in this series did not appear to be altered by x-ray findings, Computed tomography was most beneficial in the management of orbital fractures (N = 7), Plain films affected mostly the evaluation of mandibular injuries (N = 7), Selective use of CT scan could lead to hospital savings estimated at $11,864 for the diagnosis of facial fractures after blunt trauma. Conclusion: Physical examination reliably assessed the facial skeleton for clinically significant fractures in the majority of patients, In an alert and cooperative patient, CT scan is not required before operative repair in all cases. CT scans are expensive, time-consuming, and labor-intensive and in selected cases add little clinical information to that obtained by physical examination and plain films.