Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?

ABSTRACT

Introduction: Because of its functional and cosmetic importance, facial injuries, especially bony fractures are clinically very significant. Missed and maltreated fractures might result in malocclusion and disfigurement of the face, thus making accurate diagnosis of the fracture very essential. In earlier times, conventional radiography along with clinical examination played a major role in diagnosis of maxillofacial fractures. However, it was noted that the overlapping nature of bones and the inability to visualise soft tissue swelling and fracture displacement, especially in face, makes radiography less reliable and useful. Computed tomography (CT), also called as X-ray computed radiography, has helped in solving this problem. This clinical study is to compare three-dimensional (3D) CT reconstruction with conventional radiography in evaluating the maxillofacial fractures preoperatively and effecting the surgical management, accordingly. Materials and Methods: Fifty patients, with suspected maxillofacial fractures on clinical examination, were subjected to conventional radiography and CT face with 3D reconstruction. The number and site of fractures in zygoma, maxilla, mandible and nose, detected by both the methods, were enumerated and compared. The final bearing of these additional fractures, on the management protocol, was analysed. Results: CT proved superior to conventional radiography in diagnosing additional number of fractures in zygoma, maxilla, mandible (subcondylar) and nasal bone. Coronal and axial images were found to be significantly more diagnostic in fracture sites such as zygomaticomaxillary complex, orbital floor, arch, lateral maxillary wall and anterior maxillary wall. Conclusion: 3D images gave an inside out picture of the actual sites of fractures. It acted as mind’s eye for pre-operative planning and intra-operative execution of surgery. Better surgical treatment could be given to 33% of the cases because of better diagnostic ability of CT.

KEY WORDS

Computed tomography scan in maxillofacial fracture - diagnostic tools in facial fractures - radiography in maxillofacial fractures - three-dimensional computed tomography in facial fractures

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 Saheeb BD. Influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes [corrected]. West Afr J Med 2003; 22146-9
• 2 Prysi AF, Sargent LA, Franklin JD. Rigid facial skeletal fixation: Advances in treatment. South Med J 1989; 82: 727-32, 735
• 3 Johnson Jr DH. CT of maxillofacial trauma. Radiol Clin North Am 1984; 22: 131-44
• 4 Mayer JS, Wainwright DJ, Yeakley JW, Lee KF, Harris Jr JH, Kulkarni M. The role of three-dimensional computed tomography in the management of maxillofacial trauma. J Trauma 1988; 28: 1043-53
• 5 Chandran A, Hyder AA, Peek-Asa C. The global burden of unintentional injuries and an agenda for progress. Epidemiol Rev 2010; 32: 110-20
• 6 Smith H, Peek-Asa C, Nesheim D, Nish A, Normandin P, Sahr S. Etiology, diagnosis, and characteristics of facial fracture at a midwestern level I trauma center. J Trauma Nurs 2012; 19: 57-65
• 7 Girotto JA, MacKenzie E, Fowler C, Redett R, Robertson B, Manson PN. Long-term physical impairment and functional outcomes after complex facial fractures. Plast Reconstr Surg 2001; 108: 312-27
• 8 Tung TC, Tseng WS, Chen CT, Lai JP, Chen YR. Acute life-threatening injuries in facial fracture patients: A review of 1,025 patients. J Trauma 2000; 49: 420-4
• 9 van Hoof RF, Merkx CA, Stekelenburg EC. The different patterns of fractures of the facial skeleton in four European countries. Int J Oral Surg 1977; 6: 3-11
• 10 Sohns JM, Staab W, Sohns C, Schwarz A, Streit U, Hosseini AS. et al. Current perspective of multidetector computed tomography (MDCT) in patients after midface and craniofacial trauma. Clin Imaging 2013; 37: 728-33
• 11 Erol B, Tanrikulu R, Görgün B. Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience). J Craniomaxillofac Surg 2004; 32: 308-13
• 12 Oji C. Maxillofacial injuries. Plast Reconstr Surg 1996; 97: 866-8
• 13 Brown RD, Cowpe JG. Patterns of maxillofacial trauma in two different cultures A comparison between Riyadh and Tayside. J R Coll Surg Edinb 1985; 30: 299-302
• 14 Tanrikulu R, Erol B. Comparison of computed tomography with conventional radiography for midfacial fractures. Dentomaxillofac Radiol 2001; 30: 141-6
• 15 Reuben AD, Watt-Smith SR, Dobson D, Golding SJ. A comparative study of evaluation of radiographs, CT and 3D reformatted CT in facial trauma: What is the role of 3D?. Br J Radiol 2005; 78: 198-201
• 16 Gillespie JE, Isherwood I, Barker GR, Quayle AA. Three-dimensional reformations of computed tomography in the assessment of facial trauma. Clin Radiol 1987; 38: 523-6
• 17 Dos Santos DT, Costa e Silva AP, Vannier MW, Cavalcanti MG. Validity of multislice computerized tomography for diagnosis of maxillofacial fractures using an independent workstation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 715-20
• 18 Klenk G, Kovacs A. Do we need three-dimensional computed tomography in maxillofacial surgery?. J Craniofac Surg 2004; 15: 842-50
• 19 Baek HJ, Kim DW, Ryu JH, Lee YJ. Identification of nasal bone fractures on conventional radiography and facial CT: Comparison of the diagnostic accuracy in different imaging modalities and analysis of interobserver reliability. Iran J Radiol 2013; 10: 140-7