Facial X-rays

X-rays are the cornerstone of investigation of ZMC and zygomatic arch injury in the ED. However there is currently no validated decision rule for the ordering of facial x-rays. The decision to order an x-ray must therefore be based entirely on clinical acumen or locally developed guidelines.

It is important to realise that adequate facial x-rays can only be achieved in a co-operative, still patient and provided cervical spine injury has been ruled out . (See image of facial x-ray being taken). Often ‘Saturday night’ films, taken in intoxicated or uncooperative patients, are of a technically poor quality and should not be used to definitively exclude a fracture. Arrangements should be made for further assessment once the patient is more co-operative.

Having made the decision to order facial imaging, the clinician is then faced with a choice of different views to visualise the ZMC and zygomatic arch including:

  • Lateral facial view

  • Occipitomental 15o (OM15) and occipitomental 30o (OM30) views

  • Submentovertical view