Comparative evaluation of different radiographic projections of zygomatic complex fractures

Diagnosis of zygomaticomaxillary fractures is a major problem in radiographic interpretation. The purpose of the present study was to evaluate several radiographic examinations performed in an emergency room to diagnose zygomatic complex (ZC) fractures, in order to determine which is the single best radiographic projection for this purpose. Radiographs of 160 patients with ZC fractures were evaluated retrospectively. The modified P-A projection (10 degrees-20 degrees) provided a clear image of the frontozygomatic, infra-orbital rim and temporozygomatic fracture lines in all cases. In half the cases, the modified P-A projection also clearly demonstrated the fracture line in the zygomatic maxillary buttress. On the other hand, the Water's view demonstrated the fracture line in the zygomatic maxillary buttress and the temporozygomatic bone in all cases, but in only 65% of the cases was the fracture line in the infra-orbital rim and the frontozygomatic bones shown. The modified P-A projection was found to be the single best radiographic examination that should be performed in the emergency room to diagnose ZC fractures.