ABC of emergency radiology. Maxillofacial radiographs.

Abstract

This article deals with the problems facing non-specialist doctors requesting emergency radiographs of facial bones. An appropriate history and clinical examination will lead to suspicion of maxillofacial trauma and other pathology. We describe a systematic approach to requesting and interpreting maxillofacial views. Knowledge of the normal anatomy and radiological appearance of the skull is essential to interpreting radiographs of the face (see article on skull, 4 December,pp 1476-81). The face can be divided into three areas: the upper third - area above the superior orbital margin; the middle third - area between the superior orbital margin above and the occlusal plane below; and the lower third - the lower jaw (mandible). Standard radiographic investigation of the face is describe with reference to these three areas. FIG 1 Lateral radiograph with line drawing showing radiological anatomy. The mechanism of injury is an important aid to identifying the specific injury and any possible associated injuries. It can help decide which type of film to request and the urgency of the request. Isolated injuries to the maxillofacial skeleton commonly result from an assault. More severe injuries occur after high energy transfer (for example, road traffic accidents) and may be associated with injuries to the head, neck, chest, and other body regions. Good quality, carefully positioned radiographs are required. This can be difficult to achieve in patients presenting to the emergency department (because of multiple injuries or alcohol intoxication). Poor quality and incorrectly positioned films must not be accepted. Radiology of a clinically suspected maxillofacial injury can often be delayed until the patient is more cooperative or good quality films can be taken. The standard radiographic projections are listed below. Each projection provides only a limited amount of information and several views are therefore required to assess an injury fully. The clinical findings should be used …