Role of routine nonenhanced head computed tomography scan in excluding orbital, maxillary, or zygomatic fractures secondary to blunt head trauma

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Role of routine nonenhanced head computed
tomography scanin excluding orbital, maxillary,
or zygomatic fractures secondaryto blunt head
trauma

• 9100047
• ???

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• The purpose ,determine the necessity of a
  dedicated facial bone/orb(CT) ,fracture
  surveillance ,blunt head trauma
• routine nonenhanced head CT scan is negative.

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• A positive head CT scan an airfluid level
• paranasal sinuses ,maxillary, orbital, zygomatic
  osseous structures.
• Intracranial/parenchymal pathology was not
  evaluated in this way.

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Method

• these 65 patients, none subsequently had a
  positive facial bone or orbit CT scan.
• The sensitivity are100.

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• a negative nonenhanced head CT scan precludes
  the need for dedicated facial bone ,orbital CT
  scan
• unnecessary radiation exposure, health
• care costs, and time

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• The clear sinus sign
• the paranasal sinus walls results in hemorrhage.
  
• not associated with paranasal sinus fluid.

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• saves patient unneeded time in the Emergency
  Department,
• saves them from potentially harmful radiation
• saves healthcare dollars.

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Materials and methods

• The avera patient age was 44.5 years, and 59 of
  the patients were male.

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• Nasal bone fractures were noted incidentally
  study.
• No evaluation was made regarding
  intracranial/parenchymal pathology.

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• Fig. 1 Scout image from routine noncontrast head
  CT scan
• demonstrating image acquisition protocol

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Table 1 Correlation of imaging results
Head CT Head CT Totals
Facial bone/orbit CT 42 0 42 Facial bone/orbit CT - 8 65 73 Totals 50 65 115
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• Eight patients with a positive nonenhanced head
  CT
• scan subsequently had a negative facial
  bone/orbit CT.
• These patients were found to have free fluid
  within a paranasal sinus on the head CT scan.
• Etiologically this fluid was determined to be
  secondary to an isolated nasal bone fracture (in
  five cases) or an inflammatory
• process.

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Discussion

• scan was defined as showing either an airfluid
  level in a paranasal
• A positive head CT
• sinus or evidence for a maxillary, orbit, or
  zygomatic fracture.
• The free fluid within the sinus results from
• injury to the lining of the paranasal sinuses.
  This mucoperiosteu contains a very rich vascular

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• Axial scans through the zygoma are quite
  sensitive for a displaced fracture
• Nasal bone fractures are often clinically evident
  and can be confirmed with plain film radiography

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Fig. 3 Direct coronal image verifies fractures of
the inferior rightorbit and lateral wall of the
right maxillary sinus
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Fig. 4 Axial CT image reveals minimally displaced
fracture of theleft zygomatic process
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Fig. 5 Plain film image demonstrates a nasal bone
fracture