Efficacy of a single occipitomental radiograph to screen for midfacial fractures

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.