Pantomography vs Mandibular Series for the Detection of Mandibular Fractures

Abstract

Abstract. Objective: The two primary radiographic techniques used for the evaluation of mandible injury are a pantomographic series (PS) and the standard four-view mandibular series (MS). Despite a tenuous foundation, there is apparent bias in favor of PS compared with MS. Many emergency departments do not have ready access to the specialized equipment necessary to perform a pantomographic study. The hypothesis of this study was that a high-quality standard MS is as sensitive and specific as a PS in the detection of mandibular fractures. Methods: This was a prospective, blinded study of 54 patients presenting with acute mandibular injury comparing MS and PS. The study design used two board-certified emergency physicians and a single staff radiologist who read a series of MS and PS films in a randomized fashion without access to clinical information or identifying patient data. The absolute number of fractures present was determined by a neuroradiologist with access to both MS and PS simultaneously as well as pertinent clinical information. Results: Thirty patients had 47 mandibular fractures. The sensitivity for fracture detection for each physician was 0.85, 0.77, and 0.89 with MS and 0.79, 0.74, and 0.83 with PS (p Ն 0.51, p Ն 1.00, and p Ն 0.51, respectively, McNemar's binomial test). The specificity for fracture detection for each physician was 0.88, 0.92, and 0.96 for MS and 0.96, 1.00, and 0.92 for PS (p > 0.625, p > 0.50, and p = 1.00, respectively, McNemar's binomial test). Conclusions: A standard mandibular series is as sensitive and specific as pantomography in the detection of mandibular fractures.

Radiological investigation of acute mandibular injury

“…For patients needing to stay supine with a collar on, only anteroposterior/lateral/oblique views are attainable,[ 69 ] with the main limitation here being that the condylar region is poorly visualized and displacement is difficult to assess. [ 69 70 ] An orthopantomogram, Clementscitsch, and posteroanterior views are unfeasible in this case given the person is unable to stand or move his/her neck; hence, in these patients, CT is the preferred modality by default.…”

Imaging of Mandibular Trauma: ROC Analysis

“…A recently conducted study 20 that explored the diagnostic potential of these examinations based on clinical studies without a criterion standard to compare the observers' interpretations concluded that mandibular series performed superiorly to panoramic radiographs. We used cadaver specimens in order to be able to determine the ground truth so that the diagnostic accuracy for the imaging modalities of interest could be appropriately determined through an ROC analysis.…”

“…Previous studies have been clinical evaluations with no criterion standard other than the subjective opinions of an expert. 2,[20][21][22] Panoramic images have to be exposed appropriately in order for the technique to be diagnostically productive. The panoramic radiograph is very useful in that the entire mandible is adequately visualized if patient positioning and choice of exposure parameters are adequate.…”

“…Most panoramic imaging units come with automatic exposure controls and are relatively easy to use. In addition, most units provide the capability to image the tempo- [20][21][22] evaluating panoramic radiographs, irrespective of the results reported, making it very difficult for the diagnostician to understand the clinical usefulness of this type of examination in mandibular fracture detection. Older panoramic units output split images of the mandible with midline artifacts.…”

“…A clinical study using a convenience sample would not facilitate this. The radiographic modalities would have to be compared with themselves in a clinical study, 2,[20][21][22] involving a subjective decision-making process through forced consensus, without using a criterion standard. However, extrapolation of the results of this investigation need to be made with caution to the actual clinical setting until a clinical study is attempted along the same lines as this investigation, which will take into account the various drawbacks of previous studies 2,[20][21][22] as outlined in this report and the suggestions we have, to circumvent these.…”