Haworth et al reported a clinical prediction rule which can help to identify a patient with a displaced zygomatico-maxillary fracture. This can help guide imaging studies. The authors are from University of Bristol, University Hospitals of Leicester and Glouchestershire Hospitals NHS Trust.


(1) palpable bony step

(2) lateral sub-conjunctival hemorrhage with no posterior limit

(3) anesthesia or paresthesia to lip, cheek or side of nose

(4) palpable emphysema


The presence of one or more observations was associated with a displaced zygomatico-maxillary fracture.


An additional finding associated with fracture was bony asymmetry.



The sensitivity was 100% with a specificity of 73%.

The negative predictive value was 100%.

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