Facial fractures - X‑ray interpretation
This section gives a focused, ED‑oriented approach to interpreting plain radiographs for facial trauma: the common projections used in urgent care, a reproducible systematic method (McGrigor‑Campbell / Dolan lines), the key radiographic signs to seek, common pitfalls, and clear indications to escalate to CT or specialist review. It also incorporates UK imaging governance and patient‑safety points (hot reporting and escalation) in line with NICE and RCEM guidance (NICE HTG739, NG37; RCEMLearning).
Role of plain radiographs in the ED
- Plain films are rapid and widely available, and remain useful for many non‑complex facial injuries in urgent care.
- Sensitivity is limited for mid‑face, orbital floor and complex fractures compared with CT; use plain films as part of the overall trauma assessment (ABCDE) and as an initial screening tool.
- If clinical concern persists or films are inconclusive, obtain CT (NICE NG37, NG232).
- Safety and governance: if a plain film will influence disposition or definitive management, obtain a formal (hot) report by a radiologist or trained reporting radiographer before discharge - do not rely solely on an ED clinician’s provisional read (NICE HTG739).
Standard projections and when to use them
- Occipito‑mental (OM) view (standard): demonstrates the upper and middle face including orbital rims, frontal sinuses, zygomatic arches and maxillary antra. Good first‑line view for many mid‑face injuries.
- Occipito‑mental 30°...
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