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Dedicated High-resolution Maxillo-facial Computed Tomography In Determining The Operative Management Of Facial Trauma Patients: Is It Necessary?
Vasanth S. Kotamarti, M.D., Ankoor Talwar, B.S., M.B.A., Kanthi Bommareddy, B.S., Erin Harris, B.S., Maxwell Sandberg, B.S., Adee Heiman, M.D., Joseph A. Ricci, M.D..
Albany Medical Center, Albany, NY, USA.

Introduction: Computed tomography (CT) has become invaluable in the diagnosis of craniofacial pathology. For trauma patients, CT head (CTH) scans obtained to assess for intracranial injury may reveal facial fractures. Patients without simultaneous CT maxillofacial (CTMF) scans often undergo additional imaging to fully characterize the injury, increasing exposure to ionizing radiation. The aim of this study was to assess differences in fracture detection between the two scans and, more importantly, whether obtaining CTMF in addition to CTH would change management decisions.
Methods: A retrospective chart review of all patients presenting with facial trauma between January 2009 to May 2019. CTH and CTMF scans were reviewed. Demographics, injury mechanism were collected. Fractures detected by CTH and CTMF scans were identified, and operative status was determined by radiographic criteria. Fractures were categorized as skull, frontal sinus, and midface (orbital, nasal, naso-orbito-ethmoid, zygoma, and maxilla). Mandible fractures were not assessed as they are not reliably captured by CTH. Differences in the fractures identified by each scan were compared to determine if management changed as a result. Univariate analysis was performed using a paired-samples t-test and a Chi square test.
Results: Data are reported from 899 patients. Patients were predominantly male (75.3%) with median age 39.8-years-old. The most common mechanisms of injury were motor vehicle accident (35.9%), fall (21.8%), motorcycle accident (9.7%), and pedestrian struck (9.0%). The most commonly identified fractures involved the orbit, nasal bones, and maxilla. CTMF detected a total of 960 more midface fractures (p<0.001) than CTH. Specifically significantly greater numbers of all midface fracture types were detected with CTH (p<0.001). Additionally, CTMF identified 21 more frontal sinus fractures (p=0.001) No significant difference was seen in skull fractures. Change in operative status occurred in 27.3% of cases.
Conclusion: This study represents the largest direct comparison of CTH and CTMF in identifying facial fractures. CTMF is unsurprisingly superior in identifying all facial fractures, especially those of the orbit, nasal bones, and maxilla. This difference results in meaningful change in management. Serious consideration should be given to obtaining CTMF scans concurrently with CTH in facial trauma patients to prevent delay in diagnosis and reduce overall radiation dose.
Table 1. Patient demographics

Total
Patients899
Age (median; y)39.817.0
Gender
Male677 (75.3%)
Female222 (24.7%)
Length of stay (median; d)75.5
Mechanism
Motor vehicle accident323 (35.9%)
Fall196 (21.8%)
Motorcycle accident87 (9.7%)
Pedestrian struck81 (9.0%)
Assault77 (8.6%)
Bicycle accident50 (5.6%)
Gunshot wound24 (2.7%)
Sports17 (1.9%)
Industrial4 (0.4%)
Animal2 (0.2%)
Other38 (4.2%)
Insurance status
Public294 (32.7%)
Private577 (64.2%)
None28 (3.1%)
State of residence
New York803 (89.3%)
Other96 (10.7%)


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