Imaging of midface fractures-a retrospective study.

Aim: To determine the number of patients that received plain facial view radiographs as well as computed tomography (CT) scans in diagnosing their midface fractures.

Methods: Data was collected from our department of maxillofacial surgery trauma database. Patients with midface fractures sustained over an 18-month period were included (n=207) and further categorised into two groups; single-system facial trauma or multi-system trauma. Patient demographics, mechanism of injury, fracture location, modality of imaging and treatment were recorded.

Results: Of those with single-system facial trauma (n=158), 9% received plain films only, 50.5% received CT imaging only, while 40.5% received both plain films and CT. Of the population that received plain films, 82.1% of patients required a further CT scan to aid in diagnosis and treatment planning. Of those patients who received both modalities of imaging, 70% were surgically managed to reduce and/or fixate their fractures. All 49 patients with multi-system trauma received a brain/head CT as part of their routine trauma work-up, and 46 of these patients had adequate midface views included in this scan (93.9%). However, 6.1% of patients needed an additional facial bones CT for diagnosis of facial fractures.

Conclusions: 40.5% of patients with single-system facial trauma received both plain radiographs as well as CT imaging. Additionally, 82.1% of all patients who had plain radiographs went on to have a further facial CT. Furthermore, 70% of these patients were surgically managed, inferring that this population may have benefitted from receiving a CT scan from the outset. This is not in line with the standard for pre-operative imaging of midface fractures in the literature, and a clinical pathway could be implemented across the Midland district health boards to guide the clinician in requesting appropriate pre-operative imaging of these fractures. This will aim to avoid delays in diagnosis, reduce radiation burden and create improved surgical planning and outcomes for our patients, while also enhancing healthcare resource allocation.