Zygomaticomaxillary fractures revisited
mkantor at UMDNJ.EDU
Fri Nov 30 11:54:38 PST 2001
I, too, attended the RSNA meeting this week, although not the particular
CE sessions that Allan attended. However, in years past I've attend a
variety of comparable RSNA sessions (imaging of facial trauma, sinus
imaging, c-spine imaging, et cetera).
The speakers are quite reputable and knowledgable, but like most CE
speakers they tend to present the most interesting cases in their
collection, not necessarily the most representative cases. This raises
1. How many non-productive CT examinations were conducted for every
"positive" examination that showed nasolacrimal canal involvement, et
2. Among the "positive" examinations used to illustrate the point, how
many patients had signs or symptoms that suggested injury to the nearby
structures versus how many were truly clinically occult? To put it another
way, could clinical signs and symptoms be used as selection criteria to
determine which patients should be evaluated with a simple SMV radiograph
and which by CT?
3. Among patients without any clinicial indicators of anything more severe
than a simple zygomatic arch fracture, how many would suffered untoward
results due to the lack of a CT examination?
The experience of experts is valuable and worth considering, but is often
nonreprestative by the fact that they are experts. Experts often work at
academic health centers, tertiary care centers, or major trauma centers
(Level I, in the U.S.). The patients they see are often skewed to the more
extreme or severe end of the distribution. The experience of experts is,
therefore, often biased and not necessarily the best basis for action by
the "common" radiologist.
It could certainly be a problem if the standard of care were dictated by
conclusions offered by CE speakers who present little evidence beyond "In
On Thu, 29 Nov 2001, Allan G. Farman wrote:
> In attending the RSNA meeting in Chicago this week, I was able to attend
> a variety of CE options related to the earlier question of appropriate
> imaging procedures for zygomaticomaxillary fractures. The procedure
> being advocated here is multislice/multichannel spiral CT with the
> rationale being the clinical need to assess damage that might impact on
> such structures as the nasolacrimal canal, the lateral rectus muscle of
> the eye...and perhaps also intracranial hemorrhage. Cases of such
> functionally important associations were illustrated. Apparently, CT is
> now the primary imaging modality for maxillofacial trauma involving the
> zygomatic arch and zygomatico-maxillary complex.
> Evidence-based studies such as that previously referrer to from Europe
> are generally very useful; however, they tend to suffer from the fact
> that they cannot keep pace with the rapid changes in technology. It
> could certainly be a problem if the standard of care were dictated by
> conclusions made from evaluation of obsolete methods.
> Allan G. Farman
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