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Which facial views for facial trauma?
  1. Kerstin Hogg, Clinical Research Fellow,
  2. Margaret Maloba, Specialist Registrar
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether a reduced number of facial radiographs had acceptable clinical utility at detecting facial fractures after trauma. Altogether 614 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

    • trauma
    • BETs
    • radiography

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    Report by Kerstin Hogg,Clinical Research FellowChecked by Margaret Maloba, Specialist Registrar

    Clinical scenario

    An 18 year old man has been assaulted and presents to the emergency department. He has a swollen, tender left zygoma and you would like to exclude an underlying fracture. The radiology department produce three views—the OM, OM30, and lateral. You wonder whether all three views are necessary to exclude a fracture.

    Three part question

    In a [patient with facial trauma] which [facial views] are necessary for [diagnosing facial fractures]?

    Search strategy

    Medline 1966-07/04 using the OVID interface. ([Exp Facial bones OR facial.mp OR exp Facial injuries] AND [exp Zygomatic fractures OR exp Fractures OR exp Maxillary fractures OR fracture$.mp] AND [exp X-Rays OR radiograph$.mp OR X ray.mp]) LIMIT to human AND English language.

    Search outcome

    Altogether 614 papers were found of which five were of some relevance to the clinical question. These five papers are shown in table 1.

    Table 1

    Comment(s)

    These studies vary in quality.

    CLINICAL BOTTOM LINE

    Requesting one OM view in the emergency department will save cost, time, and radiation, however the evidence to date suggests that the emergency doctor may miss an occasional midfacial fracture. At least two views should be taken.

    Report by Kerstin Hogg,Clinical Research FellowChecked by Margaret Maloba, Specialist Registrar

    References

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