RESUMEN
PURPOSE: The purpose of this study was to analyze the prevalence of and complications resulting from temporal bone fractures in adult and pediatric patients evaluated for cranio-facial trauma in an emergency setting. METHODS: A retrospective blinded analysis of CT scans of a series of 294 consecutive adult and pediatric patients with cranio-facial trauma investigated in the emergency setting was conducted. Findings were compared between the two populations. Preliminary reports made by on-call residents were compared with the retrospective analysis, which was performed in consensus by two experienced readers and served as reference standard. RESULTS: CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%); p < 0.05. Fractures were longitudinal, transverse and mixed in 69.5%, 10.3% and 19.8% of cases, respectively. Most fractures were otic-sparing fractures (95.2%). Involvement of the external auditory canal, ossicular chain and the osseous structures surrounding the facial nerve was present in 72.2%, 8.7% and 6.3% of cases, respectively. Temporal bone fractures extended into the venous sinuses/jugular foramen and carotid canal in 18.3% and 17.5% of cases, respectively. Vascular injuries (carotid dissection and venous thrombosis) were more common in children than in adults (13.6% versus 5.3%); however, the observed difference did not reach statistical significance. 79.5% of patients with temporal bone fractures had both brain injuries and fractures of the facial bones and cranial vault. Brain injuries were more common in adults (90.4%) than in children (63.6%), p = 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%). CONCLUSIONS: Temporal bone fractures and related complications are common in patients with cranio-facial trauma and need to be thoroughly looked for; the pattern of associated injuries is slightly different in children and in adults.
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Fracturas Craneales , Hueso Temporal , Humanos , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/lesiones , Masculino , Femenino , Adulto , Niño , Estudios Retrospectivos , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/complicaciones , Adolescente , Persona de Mediana Edad , Preescolar , Anciano , Adulto Joven , Anciano de 80 o más Años , Lactante , Tomografía Computarizada Multidetector/métodos , Traumatismos Faciales/diagnóstico por imagen , Prevalencia , Servicio de Urgencia en Hospital , Traumatismos Craneocerebrales/diagnóstico por imagen , Traumatismos Craneocerebrales/complicaciones , Tomografía Computarizada por Rayos X/métodosRESUMEN
A man in his 30s presented to the emergency department with a history of injury to the face with a crowbar. He was discharged from the department, in the absence of any facial bone fractures and given normal examination findings, except for a puncture wound on the mentum. The patient then re-presented within 24 hours with extensive cervical emphysema extending into the mediastinal cavity.He was referred to ear, nose and throat team for further management. CT scan of the chest and neck showed extensive surgical emphysema and a pneumomediastinum. The patient was managed conservatively and recovered well with no significant sequelae.Even in the absence of facial bone fractures, it is imperative to understand the force of impact which should prompt a consideration of imaging of the chest. Appropriate advice regarding avoidance of Valsalva manoeuvres will help prevent extensive propagation of air through the fascial planes that can result in a pneumomediastinum.
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Mejilla , Enfisema Mediastínico , Tomografía Computarizada por Rayos X , Humanos , Masculino , Enfisema Mediastínico/etiología , Enfisema Mediastínico/diagnóstico por imagen , Adulto , Mejilla/lesiones , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/diagnóstico por imagen , Traumatismos Faciales/complicaciones , Traumatismos Faciales/diagnóstico por imagen , Traumatismos Torácicos/complicacionesRESUMEN
PURPOSE: This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS: We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS: We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS: Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.
Asunto(s)
Traumatismos Faciales , Traumatismos del Cuello , Traumatismos Vertebrales , Humanos , Estudios Retrospectivos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/lesiones , Traumatismos Faciales/diagnóstico por imagen , Traumatismos Faciales/epidemiología , Traumatismos Faciales/complicaciones , Traumatismos Vertebrales/diagnóstico por imagen , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/etiología , Traumatismos del Cuello/complicaciones , Factores de Riesgo , Puntaje de Gravedad del TraumatismoRESUMEN
La fractura orbitaria por estallido o fractura en "blow out" es una de las fracturas más comunes a nivel facial por lo que su importancia reside en saber identificarlas por el enmascaramiento clínico que podría o no, estar presente. Es de vital importancia complementar la valoración clínica con estudios de imagenología que confirmen las sospechas clínicas. De no hacerlo si el paciente no consulta a un servicio médico quirúrgico la pérdida de la capacidad funcional o la debilitación persistente en la salud ocasionada por la fractura no podrá ser validada en un Dictamen Médico Legal de Secuelas.
The orbital blow out fracture is one of the most common fractures at facial level, so its importance lies in knowing how to identify them due to the clinical masking that may or may not be present. It is of vital importance to complement the clinical evaluation with imaging studies to confirm the clinical suspicions. Otherwise, if the patient does not consult a surgical medical service, the loss of functional capacity or the persistent debilitation in health caused by the fracture cannot be validated in a Forensic Medical Report of Sequelae.
Asunto(s)
Humanos , Masculino , Adulto , Fracturas Orbitales/diagnóstico , Diplopía , Traumatismos Faciales/diagnóstico por imagen , Costa Rica , Medicina LegalRESUMEN
Abstract Objective: To present the profile of hospitalizations due to transport accidents in individuals aged 0-19 years in a reference hospital for urgent and emergency traumatology care. Material and Methods: This retrospective study is grounded on analyzing medical records of children and adolescents hospitalized due to transport accidents in 2016 and 2017. The bivariate analyses included Chi-square and Fischer's exact tests and binary logistic regression, with a 5% significance level. Results: Four hundred and seventy-five (43.7%) of the 1,088 medical records investigated corresponded to transport accidents, and accidents involving motorcycles were the most frequent (68.3%), affecting adolescents (81.3%), while children were more involved in accidents as pedestrians (57.1%). Advancing age increases the likelihood of the outcome, with a significant association in the multivariate analysis (p<0.001). The mandible was most frequently affected in maxillofacial fractures. Conclusion: Transport accidents predominantly affect male adolescents, involving motorcycles, and the lower limbs are the most affected. The mandible was the most affected bone in maxillofacial fractures.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Accidentes de Tránsito , Niño , Adolescente , Traumatismos Faciales/diagnóstico por imagen , Víctimas de Tránsito , Hospitalización , Distribución de Chi-Cuadrado , Modelos Logísticos , Registros Médicos , Análisis Multivariante , Estudios Retrospectivos , Hospitales de Urgencia , Fracturas MaxilaresRESUMEN
PURPOSE: To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). METHODS: A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution's violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns. RESULTS: The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19-76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients. CONCLUSION: /advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.
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Traumatismos Faciales , Violencia de Pareja , Fracturas Craneales , Adulto , Anciano , Traumatismos Faciales/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Clinicians who manage facial fractures often rely on radiologist interpretations to help with assessment and management. Among treating physicians, facial fractures are categorized into clinically relevant patterns of injury. On the other hand, while radiologists are unsurpassed at identifying individual breaks in the bone, larger fracture patterns are not always conveyed in radiology reports. PURPOSE: This study aims to assess the frequency with which the terminology describing midfacial fracture patterns is concordant among radiologists and treating clinicians. METHODS: The authors identified patients with different patterns of midfacial injury including Le Fort I, Le Fort II, Le Fort III, naso-orbito-ethmoid (NOE), and zygomaticomaxillary complex (ZMC) fractures. Plastic surgery consult notes and radiological imaging reports were reviewed for concordance in documentation of injury patterns. Identification of individual fractures consistent with the diagnosed fracture pattern was also recorded. RESULTS: Radiologists were noted to be highly successful in describing individual fractures of the facial bones, identifying at least two defining components of a fracture pattern in 96% of Le Fort, 88% of NOE, and 94% of ZMC injuries. However, when injury patterns were considered, only 32% of Le Fort, 28% of ZMC, and 6% of NOE fractures were explicitly identified in radiology reports. CONCLUSIONS: Radiologists are highly skilled in discerning individual fractures in facial trauma cases. However, less reliability was seen in the identification of fracture patterns in midfacial injury, with particular weaknesses in descriptions of NOE and ZMC fractures. This data suggests that greater focus on patterns of midfacial injury would improve the clinical applicability of radiological reports.
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Traumatismos Faciales , Fracturas Maxilares , Fracturas Craneales , Cirujanos , Huesos Faciales/diagnóstico por imagen , Huesos Faciales/lesiones , Huesos Faciales/cirugía , Traumatismos Faciales/diagnóstico por imagen , Humanos , Fracturas Maxilares/diagnóstico por imagen , Radiólogos , Reproducibilidad de los Resultados , Fracturas Craneales/diagnóstico por imagenAsunto(s)
Traumatismos del Nervio Craneal/diagnóstico por imagen , Traumatismos Faciales/diagnóstico por imagen , Neuroma/diagnóstico por imagen , Neoplasias Orbitales/diagnóstico por imagen , Adulto , Traumatismos del Nervio Craneal/etiología , Traumatismos del Nervio Craneal/cirugía , Diplopía/diagnóstico , Exoftalmia/diagnóstico , Traumatismos Faciales/etiología , Traumatismos Faciales/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Neuroma/etiología , Neuroma/cirugía , Neoplasias Orbitales/etiología , Neoplasias Orbitales/cirugíaRESUMEN
PURPOSE OF REVIEW: In the setting of the COVID-19 global pandemic, the demand for and use of telemedicine has surged in facial plastic and reconstructive surgery. This review aims to objectively review and summarize the existing evidence for the use of telemedicine within facial plastic surgery. RECENT FINDINGS: Telemedicine has been successfully implemented among subsets of facial plastic surgery patients, with high patient and provider satisfaction. Although the technology to facilitate telemedicine exists and preliminary studies demonstrate promise, multiple technological, financial, and medical barriers may persist in the postpandemic era. SUMMARY: Telemedicine will likely continue to grow and expand within facial plastic surgery moving forward, and we should continue to critically evaluate patient selection, access to care, and strategies for effective implementation to enhance current clinical practices.
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Cara/cirugía , Procedimientos de Cirugía Plástica , Telemedicina , COVID-19 , Traumatismos Faciales/diagnóstico por imagen , Traumatismos Faciales/cirugía , Parálisis Facial/clasificación , Parálisis Facial/diagnóstico , Health Insurance Portability and Accountability Act , Humanos , Participación del Paciente , Satisfacción del Paciente , Cirugía Plástica/educación , Telerradiología , Estados Unidos , Comunicación por VideoconferenciaRESUMEN
Objectives: Self-inflicted facial gunshot wounds (GSWs) result in complex but consistent injuries that are often survivable. We suggest a novel method for rapid stratification into groups that may be associated with hospital course and cost after self-inflicted facial GSWs. Methods: This is retrospective review of self-inflicted facial GSWs between January 1, 2009, and December 31, 2018, at a tertiary academic center. Patients were given a penetrating trauma rapid estimated disablity (PRED) score (1-4) based solely on radiologic imaging injury patterns. Clinicopathologic factors were then compared between groups. Results: There were 2 PRED 1 patients (15.1%), 8 PRED 2 patients (29.6%), 5 PRED 3 patients (18.5%), and 12 PRED 4 patients (44.4%). An increased PRED score was statistically associated with increasing mean days in intensive care unit (2.5 PRED 1, 4.2 PRED 2, 6 PRED 3, 11.6 PRED 4, p = 0.001), mean length of hospitalization (5.5 PRED 1, 13.1 PRED 2, 25.6 PRED 3, 39.8 PRED 4, p = 0.007), and mean cost ($) of hospitalization (22,000 PRED 1, 29,000 PRED 2, 37,000 PRED 3, 63,000 PRED 4, p = 0.01). Conclusions and Relevance: The PRED score for self-inflicted GSWs to the face is strongly associated with length of hospital stay and cost of hospitalization.
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Traumatismos Faciales/diagnóstico por imagen , Intento de Suicidio , Tomografía Computarizada por Rayos X , Índices de Gravedad del Trauma , Heridas por Arma de Fuego/diagnóstico por imagen , Adulto , Traumatismos Faciales/economía , Traumatismos Faciales/etiología , Traumatismos Faciales/terapia , Femenino , Estudios de Seguimiento , Costos de Hospital/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Intento de Suicidio/economía , Utah , Heridas por Arma de Fuego/economía , Heridas por Arma de Fuego/etiología , Heridas por Arma de Fuego/terapiaRESUMEN
Leopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.
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Mordeduras y Picaduras , Traumatismos Faciales , Traumatismos del Cuello , Panthera , Animales , Mordeduras y Picaduras/terapia , Traumatismos Faciales/diagnóstico por imagen , Traumatismos Faciales/terapia , Cabeza , Humanos , Masculino , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos del Cuello/terapiaRESUMEN
Purpose: The purpose of this study is to evaluate surgical outcomes of facial fractures after the introduction of intraoperative radiology. Methods: An historic cohort of patients without intraoperative fluoroscopy (IOF) was compared with a prospective cohort of patients with IOF. Main outcomes were postoperative complications and reoperation rate. Results: There were 51 in the non-IOF group and 49 in the IOF group. In the group with IOF 10 patients required intraoperative revisions (20.46%). Overall postoperative complication rate was higher in the non-IOF group (25.49% vs. 6.12%) due to the significantly higher bone-related complication rate (15.69% vs. 2.04%). Reoperation rate was also higher in the non-IOF group (11.76% vs. 0%). Conclusion: This study demonstrates that IOF reduces bone-related complication and reoperation rate by allowing correction of surgical errors immediately during surgery.
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Traumatismos Faciales/cirugía , Fluoroscopía , Fijación de Fractura , Cuidados Intraoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Reoperación/estadística & datos numéricos , Fracturas Craneales/cirugía , Adulto , Anciano , Traumatismos Faciales/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Errores Médicos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Fracturas Craneales/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Trauma to the face and neck is a frequent reason for emergency department attendance. Imaging is invaluable in the characterisation of such injuries, enabling delineation of fracture patterns as well as identification of vascular and other soft tissue injuries. It may also be used to prevent long-term mortality and morbidity and provide a roadmap for surgical intervention so that form and function may be restored. This article gives a pictorial review of the imaging of craniofacial trauma, stratified according to the thirds of the face, followed by a review of blunt and penetrating trauma of the neck. It discusses appropriate imaging modalities for each trauma category, describes major patterns of craniofacial trauma on cross-sectional imaging and identifies clinically relevant imaging features that should trigger subspecialist review or be of relevance to pre-surgical planning. It starts with the upper third comprising frontal sinus fractures before describing the component fractures of the middle third (including nasal, zygomaticomaxillary and orbital fractures) and then focusing on the lower third (specifically mandibular and dentoalveolar fractures). The article concludes with a review of soft tissue injuries of the neck, particularly penetrating, blunt and laryngeal trauma.
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Huesos Faciales/lesiones , Traumatismos Faciales/diagnóstico por imagen , Imagenología Tridimensional , Traumatismos del Cuello/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Traumatismos Faciales/cirugía , Humanos , Laringe/lesiones , Traumatismos del Cuello/cirugía , Procedimientos de Cirugía Plástica , Fracturas Craneales/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía , Heridas Penetrantes/diagnóstico por imagen , Heridas Penetrantes/cirugíaAsunto(s)
Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/etiología , Traumatismos Faciales/diagnóstico por imagen , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Adulto , Angiografía de Substracción Digital , Traumatismos de las Arterias Carótidas/terapia , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Embolización Terapéutica , Servicio de Urgencia en Hospital , Humanos , MasculinoRESUMEN
BACKGROUND: Treatment of isolated blow-in orbital roof fractures is still debated due to their anatomical complexity and the potential ocular and neurological related injuries. Surgery is advised in symptomatic cases while there is still controversy regarding the preferred treatment for those patients asymptomatic. OBJECTIVE: To explore the suitability of a conservative management with close imaging follow-up in asymptomatic isolated blow-in orbital roof fractures. METHODS: A single-case experience has been integrated into a systematic review of the literature to support the discussion on this specific traumatic lesion. Studies written in English and pertaining adult human subjects were further filtered according to the following eligibility criteria: clear definition of fracture's pattern, absence of concomitant cranio-facial injuries requiring management, proper description of treatment timing and outcome. RESULTS: The literature regarding treatment of isolated orbital roof fractures is of poor quality partly due to the rarity of such lesions. A total of 4 studies limited to small case series with 13 patients in total discuss thoroughly management options and timing of treatment. In particular, displaced blow-in fractures were treated conservatively in 4 patients with only 2 benefitting from this approach. Our patient showed a spontaneous realignment of a posttraumatic blow-in orbital roof deformity and at 12-month follow-up conservative management appeared a safe and effective strategy. A short-term wait-and-see approach with aggressive follow-up imaging could probably represent a reasonable option for treatment of isolated blow-in orbital roof fractures without neurological or ocular symptoms. Since literature remains confined to limited case series, future multicenter studies adopting shared evaluation parameters would help in standardizing the indications for this subset of craniofacial injuries.
Asunto(s)
Traumatismos Faciales/diagnóstico por imagen , Fracturas Orbitales/diagnóstico por imagen , Adulto , Tratamiento Conservador , Traumatismos Faciales/cirugía , Humanos , Masculino , Fracturas Orbitales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
This study standardized the methods used in the determination of orofacial injuries in Victorian family violence homicides and informed potential control selection for an analytic study. Dental service contacts with family violence victims may be intervention avenues due to the presence of abusive injuries in the orofacial region. All Victorian family homicides from January 2000-September 2018 were identified by determining the kinship/relationship and grouped by age. A 20% random sample of adult cases, aged 18-64 years was selected. The median number of orofacial injuries in categories of injury mechanisms/age/gender and the nature of abusive orofacial injuries was reported for the sample. Of 357 closed cases of family homicide, 261 were adults aged 18-64 years. Offender information and injury mechanism data was available for all closed cases, enabling case selection. Of a random sample of 50 adults, 8 cases were excluded. After 2006, CT scans and photos were present in 20 (91%) and 19 (86.4%) of 22 cases, respectively. The nature and median number of orofacial injuries showed correlation to the reported injury mechanism. Strengths and limitations of the used methods were assessed. Not all cases were compatible for assessment of orofacial injuries, thus serving as an additional criterion for exclusion in our methodology. Further detailed study of the whole population of adults should be limited to the period 2006-2018 where the data is more complete. The mechanism of injury may influence control selection for analytic studies. We present preliminary evidence of the frequent occurrence of orofacial injuries in family violence homicides.
Asunto(s)
Violencia Doméstica , Traumatismos Faciales/epidemiología , Medicina Legal/métodos , Homicidio , Traumatismos de los Dientes/epidemiología , Adolescente , Adulto , Asfixia/mortalidad , Asfixia/patología , Contusiones/mortalidad , Contusiones/patología , Traumatismos Faciales/diagnóstico por imagen , Traumatismos Faciales/patología , Femenino , Humanos , Laceraciones/mortalidad , Laceraciones/patología , Masculino , Persona de Mediana Edad , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos del Cuello/epidemiología , Traumatismos del Cuello/patología , Fotograbar , Púrpura/diagnóstico por imagen , Púrpura/epidemiología , Púrpura/patología , Tomografía Computarizada por Rayos X , Traumatismos de los Dientes/diagnóstico por imagen , Traumatismos de los Dientes/patología , Victoria/epidemiología , Adulto JovenRESUMEN
PURPOSE: The purpose of this study was to demonstrate the ability of a custom window blending algorithm to depict multicompartmental disease processes of the maxillofacial region in a single image, using routine computed tomography (CT) DICOM data. METHODS: Five cases were selected from case files demonstrating trauma, infection, and malignancy of the maxillofacial region on routine CT examinations. Images were processed with a modified Relative Attenuation-Dependent Image Overlay (RADIO) window-blending algorithm in Adobe Photoshop controlled by ExtendScript. RESULTS: The modified RADIO algorithm was able to demonstrate pertinent multicompartmental imaging findings in each of the examinations, allowing simultaneous visualization of clinically relevant bone and soft tissue findings in a single image, without needing to change window and level settings. CONCLUSION: A custom window blending algorithm can demonstrate a range of multicompartmental pathology in the maxillofacial region in a single image.
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Algoritmos , Traumatismos Faciales/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Neoplasias Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Odontalgia/diagnóstico por imagen , Adulto , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteosarcoma/diagnóstico por imagenAsunto(s)
Traumatismos Faciales/diagnóstico por imagen , Intubación Intratraqueal/efectos adversos , Fracturas Craneales/diagnóstico por imagen , Glotis/diagnóstico por imagen , Humanos , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Masculino , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
The purpose of this study is to evaluate effectiveness of clinical criteria, specifically the NEXUS Criteria, in determining the need for cervical spine imaging in victims of blunt assault to head and face. CT results from victims of blunt assault to the head and face were compared with presenting clinical findings. The presence or absence of cervical spine injury was correlated with positive NEXUS criteria to determine if the clinical criteria appropriately risk stratified patients in this population. Incidence of c-spine injury was 1.09% (7/641). For clinically significant injury, the incidence dropped to 0.16% (1/641). PPV of NEXUS criteria in blunt assault to the head and face for any injury in our study was 1.4% (95% CI: 0.6%-2.6%) compared to 2.7% (95% CI: 2.6%-2.8%) in the NEXUS validity study. PPV of NEXUS criteria in blunt assault to the head and face for significant injury in our study was 0.2% (95% CI: 0%-0.9%) compared to 1.9% (95% CI: 1.8%-2.0%) in the NEXUS validity study. The findings demonstrate a statistically significant difference between the PPV of NEXUS criteria in victims of blunt assault to the head and face when compared to all blunt trauma in the NEXUS validity study. This suggests that the clinical criteria do not adequately stratify this low risk population, leading to imaging over-utilization. Limited use of cervical spine imaging in victims of blunt assault will decrease radiation exposure and healthcare costs and will strengthen the validity of clinical risk stratification for more high-risk groups.