Radiology of maxillofacial trauma

Laine, Fred J.; Conway, William F.; Laskin, Daniel M.

doi:10.1016/0363-0188(93)90019-p

Cited by 66 publications

(47 citation statements)

References 76 publications

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“…There are several types of midface fracture, including LeFort, zygomatic complex or "tripod," orbital floor, naso-orbitoethmoidal, nasal, and nasoethmoidal, as well as those that are the result of localized trauma, such as direct injury to the anterior maxillary wall, 8,9 including projectile injuries. The midface fracture described in this article involves only the posterior Following an abrupt deceleration of a vehicle, the individual continues forward with his jaw striking the steering wheel.…”

Section: Discussionmentioning

confidence: 99%

Isolated Fractures of the Posterior Maxillary Sinus: CT Appearance and Proposed Mechanism

Simonds¹,

Whitlow²,

Chen³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:A heretofore unreported type of facial fracture is discussed. Twenty-two cases of posterior maxillary wall fracture are reviewed, of which 59% demonstrated concomitant mandibular fracture. The proposed mechanism for this injury is an impact from the ipsilateral mandibular coronoid process striking the posterior maxillary wall, with associated mandibular dislocation or fracture. As such, further investigation of the mandible may be warranted when this type of maxillary wall fracture is encountered to exclude concomitant injury.ABBREVIATIONS: GSW ϭ gunshot wound; MVC ϭ motor vehicle crash; TMJ ϭ temporomandibular joint H igh-resolution CT with multiplanar reformats and 3D postprocessing has become a standard part of the assessment of facial trauma because of the exquisite sensitivity of this imaging technique for fracture. Such sensitivity for fracture is particularly relevant in the setting of facial trauma, given that soft-tissue swelling can mask underlying fractures on physical examination.1,2 Accurate fracture detection and characterization are important because facial fractures can have long-term functional and/or cosmetic sequelae.3 Extensive work, therefore, has been invested in describing patterns and underlying mechanisms of facial fracture.4-7 Data regarding specific patterns and mechanisms of fracture can be helpful to the radiologist by increasing the sensitivity for detection of distributed injuries in which 1 traumatic finding leads to a focused search for related injuries. [4][5][6][7] In this retrospective case series, we describe a unique type of fracture characterized by an isolated one of the posterior maxillary wall and its association with mandibular dislocation and/or fracture. The proposed mechanism for this specific injury is also discussed. Materials and MethodsWe performed a retrospective review of the neuroradiology section case log from 2002 to 2009, searching for patients with the CT (either head or face CT) diagnosis of maxilla fracture limited to the posterior wall, including a possible associated mandibular fracture. All patients had been imaged in the setting of trauma by using single-section or multidetector CT scanners with 1, 4, 16, and 64 detectors (LightSpeed VCT; GE Healthcare, Milwaukee, Wisconsin). Axial CT images were generally obtained via the following parameters: 0.625-mm section thickness (3-mm thickness in old scanners), 1.375:1 pitch, 120 kV, 540 mA, no gantry tilt, 20 display FOVs, and a bone reconstruction algorithm. Multiplanar reconstruction was performed in most of the fractures, and 3D postprocessing was performed in recent years by using AquariusNET software (TeraRecon, San Mateo, California) to aid in the diagnosis and to exclude other fractures. All CT scans were reviewed independently by 2 neuroradiologists to determine if the patient had a fracture of the maxilla limited to the posterior wall as well as a concomitant fracture and/or dislocation of the mandible. Medical records of each patient were reviewed for clinical history and confirmation of ...

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Section: Discussionmentioning

confidence: 99%

Isolated Fractures of the Posterior Maxillary Sinus: CT Appearance and Proposed Mechanism

Simonds¹,

Whitlow²,

Chen³

et al. 2011

AJNR Am J Neuroradiol

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“…Conventional radiographic techniques are widely used and constitute a panoramic or mandibular series of two-dimensional transmission radiographs. 2,3 Image quality is of paramount importance, regardless of the image types used, since features of the associated clinical condition and lack of cooperation on the part of the patient 4 can mask radiographic signs of trauma. Classification of mandibular fractures is generally possible with acquisition of two sets of views perpendicular to one another.…”

Section: Abstract Objectivesmentioning

confidence: 99%

“…Classification of mandibular fractures is generally possible with acquisition of two sets of views perpendicular to one another. [5][6][7][8] The mandibular series of examinations consists of two lateral obliques, a reverse Towne's, and an anteroposterior projection. [5][6][7][8] Panoramic radiographs are used for imaging of mandibular trauma and provide a generally good view of the entire mandible, including the condylar region.…”

Section: Abstract Objectivesmentioning

confidence: 99%

“…[5][6][7][8] The mandibular series of examinations consists of two lateral obliques, a reverse Towne's, and an anteroposterior projection. [5][6][7][8] Panoramic radiographs are used for imaging of mandibular trauma and provide a generally good view of the entire mandible, including the condylar region. The use of multiple projections to detect fractures of the mandible while panoramic images are available is debatable since panoramic projections have been shown to be as efficacious as computed tomography (CT) although it does not yield information in three dimensions (3-D).…”

Section: Abstract Objectivesmentioning

confidence: 99%

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Imaging of Mandibular Trauma: ROC Analysis

Nair

2001

Academic Emergency Medicine

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Abstract. Objectives:To compare the diagnostic efficacies of panoramic radiographs, mandibular trauma series, and digitized radiographs for detection of fractures of the mandible. Methods: Fractures were induced using blunt trauma in 25 cadaver mandibles. Panoramic radiographs, digitized radiographs, and mandibular series comprising an anteroposterior view, two lateral oblique, and a reverse Towne's were used. Six observers recorded their diagnoses using a five-point confidence rating scale. The data were analyzed using receiver operating characteristic (ROC) curve analysis. Results: Significant differences based on imaging modalities were found (p < 0.0015) in the area under the curves (A z ): panoramic radiograph, 0.8762; mandibular series, 0.7521; panoramic plus anteroposterior radiographs combination, 0.8886; and digitized mandibular series, 0.7723. No observerbased differences were noted. Condylar and coronoid fractures were difficult to detect than those in other areas of the mandible (p < 0.033). Intra-and interobserver agreements were high ( w = 0.81 and 0.76, respectively). Conclusions: Panoramic radiographs are adequate for detection of mandibular fractures. Addition of an anteroposterior view augments diagnostic accuracy.

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“…The traditional approach has included plain radiographs including right and left lateral obliques, a posterior-anterior view, and a reverse Towne projection. [5][6][7][8] Pantomography or panoramic studies are recommended if suitable equipment is available. A review of two major references in emergency medicine (EM) has suggested that pantomography is superior to standard radiographs in the diagnosis of mandibular fracture.…”

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confidence: 99%

Pantomography vs Mandibular Series for the Detection of Mandibular Fractures

Guss

Clark

Peitz

et al. 2000

Academic Emergency Medicine

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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.

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Radiology of maxillofacial trauma

Cited by 66 publications

References 76 publications

Isolated Fractures of the Posterior Maxillary Sinus: CT Appearance and Proposed Mechanism

Isolated Fractures of the Posterior Maxillary Sinus: CT Appearance and Proposed Mechanism

Imaging of Mandibular Trauma: ROC Analysis

Pantomography vs Mandibular Series for the Detection of Mandibular Fractures

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