ACR Appropriateness Criteria® Imaging of Facial Trauma Following Primary Survey


Matthew S. Parsons, Mallinckrodt Institute of Radiology, Saint Louis, Missouri; Director of Neuroimaging, Barnes West County Hospital, St Louis, Missouri, 2007-present; Director of Neuroimaging, Phelps County Hospital, Rolla, Missouri, 2019-present; Emergency Department Neuroradiology Director, 2017-present; Neuroradiology Quality and Safety Officer, 2017-present; Assistant Radiology Residency Program Director, 2019-present; American Society of Head and Neck Radiology, 2011-present; American Roentgen Ray Society, 2014-present; Abstract Review Subcommittee-Neuroradiology Section 2017-present; American Society of Spine Radiology, 2015-present; Abstracts Committee 2021-2022; Co-Chair, Website Committee 2021-2022; Social Media Committee 2021-2022. Electronic address:
Bruno Policeni, Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Amy F. Juliano, Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; ACR Chair NI-RADS committee; and Mass Eye and Ear Director of Research and Academic Affairs.
Mohit Agarwal, Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; and Fellowship Program Director.
Elizabeth R. Benjamin, Emory University, Atlanta, Georgia; American Association for the Surgery of Trauma; and Trauma Medical Director, Grady Memorial Hospital Chair, Georgia Regional Trauma Advisory Committee, Region 3, Director of Surgical Simulation, Grady Memorial Hospital.
Judah Burns, Residency Program Director, Diagnostic Radiology, Montefiore Medical Center, Bronx, New York.
Timothy Doerr, Ambulatory Medical Director, Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York; American Academy of Otolaryngology-Head and Neck Surgery.
Prachi Dubey, Houston Methodist Hospital, Houston, Texas; and Alternate Councilor, TRS and Member ACR Neuroradiology Commission.
Elliott R. Friedman, University of Texas Health Science Center, Houston, Texas.
Maria K. Gule-Monroe, Medical Director of Imaging at Woodlands Houston Area Location, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Karol A. Gutowski, University of Illinois at Chicago, Chicago, Illinois; University of Chicago, Chicago, Illinois; American Society of Plastic Surgeons.
Mari Hagiwara, Neuroradiology Fellowship Program Director, New York University Langone Health, New York, New York.
Vikas Jain, Assistant Program Director of Radiology Residency Program, MetroHealth Medical Center, Cleveland, Ohio.
Tanya J. Rath, Division Chair of Neuroradiology; Education Director of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona; and President of the ENRS.
Brian Shian, University of Iowa Carver College of Medicine, Iowa City, Iowa; Primary care physician.
Devaki Shilpa Surasi, Patient Safety and Quality Officer, Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging.
M Reza Taheri, Director of Neuroradiology, George Washington University Hospital, Washington, District of Columbia.
David Zander, Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado.
Amanda S. Corey, Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Document Type

Journal Article

Publication Date



Journal of the American College of Radiology : JACR








AUC; Appropriate Use Criteria; Appropriateness Criteria; Frontal bone injury; Imaging; Mandibular injury; Maxillofacial trauma; Midface injury; Nasal bone injury


Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.