Investigations

Investigations

The nature of the injury sustained will determine the specific investigations required to facilitate diagnosis. Systemic inves - tigations may include routine haematology and biochemistry investigations, and imaging requests such as cervical spine, chest, abdominal or limb radiographs depending on the site of injury . If a mandibular fracture is suspected, an orthopantomo- gram (OPT) and a posteroanterior (PA) radiograph of the mandible should be obtained ( Figure 31.5 ). It is extr emely important to have two views at right angles to each other to avoid missing any fractures. V ery occasionally a lateral mandibular view may have to be utilised as a screening radiograph if the patient is unable to cooperate for the OPT (e.g. patients with dementia). For a suspected midface fracture, occipitomental (OM) radiographs at 10° and 30° should be obtained ( Figure 31.6 ). A CT of the facial bones would be more suitable if an orbital fracture is suspected or in the case of a high-impact injury; this will pr ovide the gold standard detail of bony structures and, as previously mentioned, should include the brain if there is any suggestion of a head injury . A three-dimensional (3D) reformatting of the CT scan allows for excellent visualisation of the maxillofacial bony structures.

History, examination and investigation /uni25CF /uni25CF /uni25CF

A detailed history of the mechanism of injury is crucial in any initial assessment A systematic approach should be adopted in examination of the craniomaxillofacial structures; a top-down approach is recommended The most common radiographs requested in facial fracture investigation are OPT and PA mandible for mandibular fractures, and OM facial views for midface fractures

Investigations

The nature of the injury sustained will determine the specific investigations required to facilitate diagnosis. Systemic inves - tigations may include routine haematology and biochemistry investigations, and imaging requests such as cervical spine, chest, abdominal or limb radiographs depending on the site of injury . If a mandibular fracture is suspected, an orthopantomo- gram (OPT) and a posteroanterior (PA) radiograph of the mandible should be obtained ( Figure 31.5 ). It is extr emely important to have two views at right angles to each other to avoid missing any fractures. V ery occasionally a lateral mandibular view may have to be utilised as a screening radiograph if the patient is unable to cooperate for the OPT (e.g. patients with dementia). For a suspected midface fracture, occipitomental (OM) radiographs at 10° and 30° should be obtained ( Figure 31.6 ). A CT of the facial bones would be more suitable if an orbital fracture is suspected or in the case of a high-impact injury; this will pr ovide the gold standard detail of bony structures and, as previously mentioned, should include the brain if there is any suggestion of a head injury . A three-dimensional (3D) reformatting of the CT scan allows for excellent visualisation of the maxillofacial bony structures.

History, examination and investigation /uni25CF /uni25CF /uni25CF

A detailed history of the mechanism of injury is crucial in any initial assessment A systematic approach should be adopted in examination of the craniomaxillofacial structures; a top-down approach is recommended The most common radiographs requested in facial fracture investigation are OPT and PA mandible for mandibular fractures, and OM facial views for midface fractures

Investigations

The nature of the injury sustained will determine the specific investigations required to facilitate diagnosis. Systemic inves - tigations may include routine haematology and biochemistry investigations, and imaging requests such as cervical spine, chest, abdominal or limb radiographs depending on the site of injury . If a mandibular fracture is suspected, an orthopantomo- gram (OPT) and a posteroanterior (PA) radiograph of the mandible should be obtained ( Figure 31.5 ). It is extr emely important to have two views at right angles to each other to avoid missing any fractures. V ery occasionally a lateral mandibular view may have to be utilised as a screening radiograph if the patient is unable to cooperate for the OPT (e.g. patients with dementia). For a suspected midface fracture, occipitomental (OM) radiographs at 10° and 30° should be obtained ( Figure 31.6 ). A CT of the facial bones would be more suitable if an orbital fracture is suspected or in the case of a high-impact injury; this will pr ovide the gold standard detail of bony structures and, as previously mentioned, should include the brain if there is any suggestion of a head injury . A three-dimensional (3D) reformatting of the CT scan allows for excellent visualisation of the maxillofacial bony structures.

History, examination and investigation /uni25CF /uni25CF /uni25CF

A detailed history of the mechanism of injury is crucial in any initial assessment A systematic approach should be adopted in examination of the craniomaxillofacial structures; a top-down approach is recommended The most common radiographs requested in facial fracture investigation are OPT and PA mandible for mandibular fractures, and OM facial views for midface fractures