Facial Bones X-ray (complete)

What it is

The face is not one bone but a stack of thin, hollow ones that overlap each other from every direction, which is why a single picture is close to useless here. A complete facial series means several exposures from different angles, each chosen to throw one part of the architecture clear of the rest — the rim of an eye socket in one, the arch of a cheekbone in another, the sinus walls and the upper jaw in others. The radiologist reads them as a set, looking for a break in the smooth line of a bone edge, a step where two pieces have shifted, or fluid collecting in a sinus below a fracture.

Why it is done

• To look for fractures after a fall, a collision, a sports injury or an assault
• To check whether a broken piece of bone has been displaced, which is what usually decides whether an injury is treated with surgery or left to heal
• To look at the sinuses and the bones around them when infection or swelling is being investigated
• To look for a foreign object in the facial soft tissues or bones

What to expect

Glasses, earrings, piercings, hairpins and removable dental appliances come off, since anything metal will cast a shadow across exactly the bones being examined. You sit or lie with your head resting against the image plate, and the technologist turns and tilts your head between exposures — chin tucked for one, chin raised for another, turned to each side for others. Each exposure asks you to hold still for a second or two. The whole series is usually finished in ten to fifteen minutes. If the injury is severe, or if the eye or the base of the skull is a concern, a CT of the face is often ordered instead of, or in addition to, plain films.

Questions worth asking

• If a CT of the face is likely to be needed anyway, is it worth doing these plain films first? Ask before both end up on the bill.
• Is this being done in an emergency department? The emergency visit level is a separate and usually much larger charge than the X-ray itself.
• Does the facility price cover the whole multi-view series, or is it quoted per view?
• If a fracture is found, is the surgeon's evaluation part of today's visit or a new appointment with its own charge?