Facial form and function: films versus physical examination

Criteria for the use of radiography for facial trauma in the emergency department have not been the subject of any critical reviews. Many recent reviews have been done on the advantages of various radiologic techniques to delineate specific facial injuries, both bony and soft tissue. No prospective study has addressed the criteria for ordering radiographs in the ED. Ideally the criteria would need only to consider the utility of studies in making therapeutic decisions. Unfortunately other considerations are involved, such as cost, medicolegal liability, and the real and imagined risks of radiation exposure. The intelligent use of radiologic examinations must be based on a thorough history and physical examination, a knowledge of the likely bony and soft tissue injuries, and an understanding of their concomitant physical signs and symptoms. In addition, the treating physician must know the options available in the radiology department.