Facial fractures are common after major blunt trauma. There are a number of diagnostic tests available for their diagnosis, including head CT, conventional facial imaging and facial CT.

Our preference has been to add a facial CT to the list of diagnostics in any patient with external evidence of facial trauma. Subjectively, it appeared that there were not many injuries being identified, and the vast majority did not require operative management. 

A review of the literature shows that head CT alone is sufficient for screening for significant facial fractures. A small retrospective series noted that the accuracy was 92%, with 90% sensitivity and 95% specificity. 

Bottom line: A head CT alone ordered for the usual indications is a very good screening test for facial fractures. If none are seen, it is unlikely that there are any fractures that require specific management. If fractures are seen, consultation with a facial surgeon is needed. However, unless the fractures involve critical areas (e.g. temporal bone near the middle ear) or are significantly displaced, the benefit of a facial CT scan is still very low since most will be treated without operation.

Reference: Computed tomography of the head as a screening examination for facial fractures. Marinaro et al. Am J Emerg Med 25, 616-619, 2007.