Diagnosis of unsuspected facial fractures on routine head computerized tomographic scans in the unconscious multiply injured patient.
OBJECTIVE
This article assessed the value of routine head computerized axial tomographic (CT) scans for diagnosis of unsuspected facial fractures and its clinical implications in the multiply injured patient who is intubated, unconscious, or sedated at the time of initial assessment and requires a head CT scan to assess for brain injury.


METHODS
At a level I trauma center from June 1, 1992 to June 1, 1993 all intubated blunt trauma patients who required routine CT scan evaluation at initial assessment were studied prospectively. Routine scanning started at the foramen magnum and included the maxilla. Patients who died within the first 24 hours were excluded.


RESULTS
The study population included 116 patients (85 male, 21 female) aged 12 to 85 years (mean, 28 years) with injury severity scores ranging from 1 to 50 (mean, 23). The mechanism of injury was: motor vehicle accidents (n = 74), motorcycling (n = 5), pedestrians accidents (n = 13), falls (n = 10), bicycling (n = 5), assaults (n = 8), and boating accident (n = 1). There were 19 suspected facial fractures; 18 required surgical repair. There were 27 unsuspected facial fractures; 13 required surgical care. Three suspected fractures were ruled out.


CONCLUSIONS
Routine head CT scans to assess for brain injury in the multiply injured patient are also very useful in the diagnosis of unsuspected facial fractures, almost half of which will require surgical intervention.
Rehm
C G
CG
Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital, USA.
Ross
S E
SE
D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001642:Bicycling / Q000293:injuries; D002648:Child; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal; D007572:Jaw Fractures / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000209:etiology; D009917:Orbital Fractures / Q000000981:diagnostic imaging; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness; D014754:Violence; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging; D015051:Zygomatic Fractures / Q000000981:diagnostic imaging