What are the key clinical signs that indicate a need for imaging in a patient with suspected maxillofacial trauma?

Key clinical signs indicating the need for imaging in a patient with suspected maxillofacial trauma include visible deformity or swelling of the facial bones, suspected open or depressed fractures, signs of basal skull fracture such as haemotympanum, periorbital ecchymosis ('panda' eyes), cerebrospinal fluid leakage from the ear or nose, and Battle's sign. Additionally, focal neurological deficits, post-traumatic seizures, persistent or worsening neurological symptoms, and multiple episodes of vomiting after injury are critical indicators for urgent imaging. A Glasgow Coma Scale (GCS) score less than 15 at 2 hours post-injury or less than 14 on initial assessment in children also warrants imaging. Mechanism of injury, such as high-impact trauma (e.g., pedestrian struck by a vehicle, falls from height), and suspicion of non-accidental injury in children further support the need for imaging. Imaging is primarily performed using CT scans to assess for fractures and intracranial injury, as plain X-rays are generally insufficient for diagnosing clinically important traumatic brain or facial injuries. Clinical signs of vascular injury or expanding hematoma in the facial region also necessitate imaging to guide urgent management. These criteria align with UK guidelines on head injury and fracture management, supplemented by literature emphasizing the importance of detailed clinical assessment to guide imaging decisions in maxillofacial trauma ¹ (Ghysen et al., 2000; Cohenca et al., 2007; Wikner et al., 2014).