Purpose: This study evaluated the use of a single 30 degrees occipitomental
radiograph as an effective screening procedure for midface fractures.
Patients and Methods: The emergency room 30 degrees occipitomental films of
105 consecutive patients with suspected midface fractures were examined in
dependently by 2 oral and maxillofacial surgeons (OMFS). They were asked to
identify whether a midfacial fracture existed in each case. They also iden
tified those cases in which they believed a computed tomography (CT) scan w
as indicated for definitive diagnosis of midfacial fractures. These finding
s and recommendations were then compared with the actual diagnosis and imag
ing studies for these patients to determine the efficacy of a single occipi
tomental film, supplemented by CT scans when indicated, in identifying midf
ace fractures.
Results: Of the 105 occipitomental films, one oral and maxillofacial surgeo
n recommended CT scans for 13 of the 105 patients, and the second recommend
ed CT scans for 26 patients. Seventeen patients actually had had CT scannin
g performed, and a midface fracture was identified in 12 cases. Of these 12
patients, 8 were treated by surgical intervention. One OMFS identified II
of the 12 fractures that were subsequently identified in the emergency room
, including all of the 8 that required surgical treatment, whereas the seco
nd OMFS identified all 12 of the fractures seen in the emergency room.
Conclusion: A single 30 degrees occipitomental radiograph, augmented with C
T scans when indicated, can accurately identify all midface fracture requir
ing treatment. The current practice of obtaining a series of plain radiogra
phs may be unnecessary.