Comparing Head and Facial Computed Tomographic Imaging in Identifying Operative Facial Fractures

Background: Patients who present for a trauma workup often have a head computed tomography (CT) performed to identify intracranial pathology. Facial fractures are routinely identified in these patients, and further imaging is the norm with dedicated facial CT scans. Additional imaging increases radiation doses; however, it is unclear if additional operative fractures are identified. The aim of this study was to examine differences between these 2 CT imaging modalities. Methods: A retrospective review of all operative facial trauma patients receiving both head and facial scans at a single institution was performed (1999-2012). Identified fracture patterns were compared between the head and facial CT scans of each patient to determine if the results correlated. Demographic information and injury mechanism were compared. Results: A total of 307 patients receiving both types of CT scan underwent facial fracture repair. In the 106 patients (35%) with differences identified fractures between the scans, 151 additional operative fractures were found through dedicated facial imaging: nasal fractures (58 vs 15; P < 0.001), midface fractures (69 vs 34; P < 0.001), zygoma fractures (51 vs 21; P < 0.001), and orbital fractures (90 vs 51; P < 0.001). No differences in demographics or mechanisms of injury were observed between groups. Conclusions: Standard head CT scans alone failed to identify a significant number of operative facial fractures compared with facial CT in 35% of patients. Dedicated facial CT scans should be considered for patients with known or suspected facial fractures, even if a head scan has been performed previously.