Radiologic screening for midfacial fractures: a single 30-degree occipitomental view is enough

The standard radiologic screening views for maxillofacial trauma in the accident and emergency department have been the Waters (30-degree occipitomental [OM]) view, the Caldwell (posteroanterior) view, and the lateral view. We wanted to see if a single 30-degree occipitomental view would be sufficient to screen for maxillofacial trauma (excluding nasal fractures).

Over a 1-year period, each of 730 patients had three radiologic views obtained for maxillofacial trauma at our emergency department. A consultant emergency physician read the single OM view for injury, and then compared his radiologic findings with those made by other doctors on the basis of the three views. The need for further computed tomographic scanning was also studied.

There were 730 patients recruited, of which 104 patients had abnormal findings on three-view screening. All the radiologic abnormalities were seen on the OM view; however, for the same 104 patients, only 48 had abnormal findings on the Caldwell views. Radiologic detail for the latter 48 patients was less obvious on the Caldwell views compared with the OM views. Other than two mandible fractures, no facial abnormality was demonstrable on any of the lateral views, even with significant bony injury on the OM views.

A single 30-degree occipitomental view would be sufficient to screen for maxillofacial trauma. Further views are unnecessary and add little clinical value. Computed tomographic scanning with three-dimensional reconstruction of the facial skeleton should be the next preferred investigation for any patient found to have fractures on the Waters views.