Efficacy of a single occipitomental radiograph to screen for midfacial fractures

This study evaluated the use of a single 30 degrees occipitomental radiograph as an effective screening procedure for midface fractures.

The emergency room 30 degrees occipitomental films of 105 consecutive patients with suspected midface fractures were examined independently by 2 oral and maxillofacial surgeons (OMFS). They were asked to identify whether a midfacial fracture existed in each case. They also identified those cases in which they believed a computed tomography (CT) scan was indicated for definitive diagnosis of midfacial fractures. These findings and recommendations were then compared with the actual diagnosis and imaging studies for these patients to determine the efficacy of a single occipitomental film, supplemented by CT scans when indicated, in identifying midface fractures.

Of the 105 occipitomental films, one oral and maxillofacial surgeon recommended CT scans for 13 of the 105 patients, and the second recommended CT scans for 26 patients. Seventeen patients actually had had CT scanning performed, and a midface fracture was identified in 12 cases. Of these 12 patients, 8 were treated by surgical intervention. One OMFS identified 11 of the 12 fractures that were subsequently identified in the emergency room, including all of the 8 that required surgical treatment, whereas the second OMFS identified all 12 of the fractures seen in the emergency room.

A single 30 degrees occipitomental radiograph, augmented with CT scans when indicated, can accurately identify all midface fracture requiring treatment. The current practice of obtaining a series of plain radiographs may be unnecessary.