Radiology, Surgery Reports Differ in Terminology

Radiologists and surgeons do not always speak the same language when discussing patients with facial fractures, according to a study published in the American Journal of Roentgenology.

Researchers from the United States and Canada examined the concordance of facial fracture classifications in patients with trauma who underwent surgery and to assess the epidemiologic findings associated with facial trauma.

The researchers retrospectively analyzed data from facial CT examinations and inpatient operative interventions performed during a one-year period. Patient demographic characteristics, the mechanism of injury, radiology report, surgical diagnosis, and clinical indications were reviewed. Fractures were documented according to bone type and were classified into the following subtypes:

• LeFort 1

• LeFort 2

• LeFort 3

• Naso-orbital-ethmoidal

• Zygomaticomaxillary complex (ZMC)

• Orbital

• Mandibular

Concordance between the radiology and surgery reports was assessed.

The results showed there were 115,000 visits to the emergency department, with 9,000 trauma activations and 3,326 facial CT examinations. A total of 156 (4.7%) underwent facial surgical intervention, and 133 cases met criteria for inclusion in the study.

The mean injury severity score was 10.2 (range, 1 to 75). The three most frequently noted injury mechanisms included 77 cases of assault (57.9%), 21 cases of traffic accidents (15.8%), and 20 falls (15 %). The three most frequently noted facial bone fractures were:

• Mandible (100 cases [75.2%])

• Maxilla (53 cases [39.8%])

• Orbit (53 cases [39.8%])

The five descriptors most frequently found in the radiology and surgery reports were the:

• Mandibular angle (25 cases)

• Orbital floor (25 cases)

• Mandibular parasymphysis (22 cases)

• Mandibular body (21 cases)

• ZMC fractures (19 cases)

A classification was not specified in 31 of the radiologic impressions (22.5%), with 28 of 31 radiologists expecting the surgeon to read the full report. The descriptors used in the radiology and surgery reports matched in 73 cases (54.9%) and differed in 51 cases (38.3 %). No classifications were used by one or both specialties in nine cases (6.8%).

The researchers concluded that for 38.3% of patients needing facial surgery, descriptors used in the radiologic and surgery reports differed. “Speaking a common language can potentially improve communication between the radiology and surgery services and can help expedite management of cases requiring surgery,” they wrote.