Facial Soft Tissue Trauma Workup

Updated: Jul 25, 2017
  • Author: Daniel D Sutphin, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Approach Considerations

Although most soft tissue facial trauma consists of contusions, abrasions, lacerations, or a combination of these that require only a careful physical examination, more complex wounds benefit from radiologic studies.

Order diagnostic studies only after determining that the patient is clinically stable. Defer studies if they may interfere with or delay clinical treatment.

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Radiography

Head and neck films

Facial injuries in which there is significant bony tenderness or obvious deformity warrant imaging to evaluate for fractures. Plain films of the face, including Water, Caldwell, and lateral views, have been historically important. Panoramic radiographic images may also be of benefit if there is concern for mandibular fractures.

Computed tomography, however, has greater sensitivity in defining bony facial trauma. Any patient with a bony stepoff or instability, periorbital swelling or contusion, Glasgow Coma Scale score less than 14, malocclusion, or tooth absence is at high risk for an associated facial fracture, and computed tomography scanning is warranted. [14] Cervical spine imaging is also imperative depending on patient complaints and the mechanism of injury, particularly in unconscious or intoxicated patients.

Arteriography

In patients in whom extensive hemorrhage occurs with questionable source, arteriography serves as an excellent study to evaluate and isolate the source of hemorrhage or to exclude major vascular injuries, particularly those of the carotid and vertebrobasilar system.

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Computed Tomography

Computed tomography is an excellent modality for diagnosing more complex facial traumatic injuries according to the criteria earlier listed. [14] It is invaluable in its ability to provide 3-dimensional relationships among the structures in question.

Obtain 2.5-mm axial and coronal cuts of the facial skeleton. In delicate and complex areas such as the eyes, obtain lateral oblique cuts through the globe to evaluate the bony architecture surrounding the orbit. If necessary, 3-dimensional reconstructions can be made for a more detailed analysis.

The main disadvantage of CT scanning is the higher dosage of radiation to which the patient is exposed.

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Magnetic Resonance Imaging

Although it avoids the need to expose patients to radiation, MRI is generally not a practical or necessary study for the evaluation of acute soft tissue facial trauma.

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