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American Association of Plastic Surgeons

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Dedicated High-resolution Maxillo-facial Computed Tomography In Determining The Operative Management Of Facial Trauma Patients: Is It Necessary?
Deepa Bhat, MD, Ankoor A. Talwar, MD, Adee Heiman, MD, Ashit Patel, MBChB, FACS, Joseph A. Ricci, MD.
Albany Medical Center, Albany, NY, USA.

Introduction: Computed tomography of the head (CTH) and maxillofacial bones (CTMF) can be performed concurrently without additive radiation exposure, but CTMF is frequently ordered separately at a later time to further evaluate facial fractures seen on CTH. This results in unnecessary ionizing radiation to the patient, increased costs, and delays in care. We aim to evaluate whether obtaining additional CTMF after CTH changes operative management of the facial trauma patient.
Methods: Retrospective chart review was performed on all patients presenting to our Level One Trauma Center between September 2016 and May 2019. Pre-determined criteria were established for facial fracture patterns to determine whether operative intervention was required. CTH and CTMF were then reviewed for each patient and compared to see if CTMF provided additional information that would necessitate/change management.
Results: Both CTH and CTMF were performed on 379 patients. CTMF identified 32.3% more fractures than CTH (more frontal sinus, orbital, nasal, naso-orbito-ethmoid, zygoma, midface, and mandible fractures) (p<0.05). CTMF findings delegated a change in operative plan in 37% of cases. Duplicate imaging was performed in 28% of patients, translating to a potential cost-savings of $50,000/year if both scans were performed simultaneously.
Conclusions: Maxillofacial CT scans are a necessary diagnostic tool in determining need for operative intervention. Head CT scans are insufficient to accurately diagnose and treat patients with facial fractures. As CTH and CTMF are constructed from the same set of images, physicians should consider ordering both scans simultaneously to limit radiation exposure, control costs, and avoid delays in care.


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