Skull and facial radiographs for fractures

In line with international and local guidelines, we would like to advise skull and facial bone x-rays to evaluate for skull vault and mid face fractures will no longer be performed.  It is widely accepted that plain radiographs have poor sensitivity and specificity in diagnosing the skull vault, the base of the skull and mid face fractures. We will continue to provide radiographs for evaluation of possible mandibular fractures.

We refer you to the resources available on the Auckland Region Health pathways regarding the management of head injury in both adults and children and management of facial/nasal trauma.

Patients with clinical signs of significant head injury with the possibility of skull fractures will be better served with assessment in the Emergency Department and imaging with CT.

Patients with potential mid face fractures can be assessed by ORL for further imaging requirements. ORL service has indicated information regarding the mechanism of injury is critical (eg. dumbbell on nose vs kick by baby foot, whether there was nosebleed etc).

From a radiation dose perspective, once 3-4 views are included with a routine skull view protocol, the radiation dose to the eyes and face approaches that of an unenhanced CT face. If significant facial trauma is suspected, the patients would typically require surgical planning with CT, which increases the radiation dose further.

Our radiologists are available for discussion if you feel there is a compelling reason for these radiographs to be performed.

Please feel free to provide feedback as we will look to implement these changes with our various branches near you soon. We would be very grateful if you could disseminate this change to your colleagues as well.