THE ROLE OF COMPUTED TOMOGRAPHIC SCANNING IN THE MANAGEMENT OF FACIALTRAUMA

Objective: To determine how often the management of patients with blun t facial trauma was altered by plain roentgenograms or facial computed tomographic (CT) scans compared with findings from physical examinati on. Method: This is a retrospective review of consecutive patients adm itted with blunt facial trauma and evaluated by the Division of Plasti c Surgery from 1988 to 1994, Physical findings were correlated with fr actures detected by plain roentgenograms or facial CT reports, Treatme nt plans were reviewed to determine how management was altered by radi ographic studies, Hospital charges were determined for the various stu dies. Results: One hundred thirty-seven records were reviewed. Thirty patients had only lacerations and no fractures, Two hundred forty-thre e fractures were detected on physical examination among 98 patients (9 1.5%). One hundred two patients (95.3%) had facial CT scans and 85 pat ients (79.4%) had facial plain films obtained. Radiographic findings i dentified a total of 255 fractures among 107 patients (78%), Ninety-fo ur patients (87.9%) required operative interventions for these facial fractures. Only 19 patients (17.8%) had management altered by radiogra phic findings: CT scan (7 patients) and plain films (12 patients). The management of 88 facial fractures (34.5%) in this series did not appe ar to be altered by x-ray findings, Computed tomography was most benef icial in the management of orbital fractures (N = 7), Plain films affe cted mostly the evaluation of mandibular injuries (N = 7), Selective u se of CT scan could lead to hospital savings estimated at $11,864 for the diagnosis of facial fractures after blunt trauma. Conclusion: Phys ical examination reliably assessed the facial skeleton for clinically significant fractures in the majority of patients, In an alert and coo perative patient, CT scan is not required before operative repair in a ll cases. CT scans are expensive, time-consuming, and labor-intensive and in selected cases add little clinical information to that obtained by physical examination and plain films.