Role of Multidetector Computed Tomography in the Evaluation of Maxillofacial Trauma

Abstract

Introduction: Maxillofacial fractures are among the commonest injuries occurring in trauma patients. Multislice computed tomography (CT) is a widely used radiological investigation that accurately reveals the number, location, and extent of the fractures as well as concomitant soft tissue injuries and has been found to be superior in the diagnosis of maxillofacial fractures owing to high sensitivity and specificity. This study was performed to assess the efficacy of axial, coronal, sagittal, and three-dimensional (3D) reformatted images in the detection of fractures in maxillofacial trauma.Materials and Methods: This was a cross-sectional descriptive study conducted on 49 adult patients with maxillofacial injuries undergoing multislice CT using a multidetector Siemens SOMATOM Emotion eco 16 slice CT scanner (Siemens AG, Munich, Germany). CT protocol consisted of non-contrast axial 16-slice helical series beam collimation ~ 3 mm, pitch ~ 0.8 -1, tube current ~ 270 mAs, voltage ~ 130 kV, Total exposure time ~ 18 seconds, total radiation ~ 200 mGy. Along with the axial, coronal and sagittal images were reconstructed with 0.5 mm increment. 3D volume-rendering images were also obtained. 3D images were compared with axial images, coronal and sagittal plane images.Results: The maximum number of cases was in the age group of 21-30 years with the male: female ratio being 5.12:1. The most common cause of injury was road traffic accidents (RTA). Mandible fractures were found to be the most common (20 patients, 40.8%) followed by fractures of nasal bone (18 patients, 36.7%). The incidence of frontal bone fractures was found to be the least (six patients, 12.24%). Our study found that 3D images are superior to axial in assessing the extent and degree of displacement of maxillofacial fractures in general. The maxillary sinus was found to be the most commonly fractured sinus (19 patients, 38.7%). Sphenoid sinus fractures were the least common (seen in two patients, 4.08%). CT findings correlated with the operative findings in most types of fractures. Conclusion:Multidetector CT with multiplanar and 3D reformation is highly accurate in the identification of fractures and assessing the extent and degree of displacement of fractures; hence, it is the imaging modality of choice in maxillofacial trauma. 3D images are much better for the detection of maxillofacial fractures compared to axial, coronal, or sagittal views, especially in maxilla and mandibular bone fractures. It is also found to be better at providing information on the patterns of the fracture lines and the displacement of the fracture fragments. Another added advantage of multidetector CT is that it is a noninvasive technique with good accuracy and a short scan time.

Frontal Sinus Fractures: An Evaluation of Patient Demographics, Mechanisms of Injury, Classification, and Management Strategies in Patients Referred to a Trauma Center, From 2014 to 2019

“…Because of the limitations of 2-dimensional radiographs, CT scanning is now considered the gold standard for diagnosing and classifying frontal bone fractures. 9,29,30 The axial, coronal, and sagittal views were used in this study to detect any fracture in the anterior and posterior walls of the frontal sinus and orbital cavity and assess the patency of the nasofrontal duct. 24,31,32 The differentiation between anterior and posterior table fractures is vital for evaluating the risk of brain damage, estimating the prognosis, and selecting the correct treatment strategy.…”

“…In the present study, the diagnosis of frontal bone fracture was made through CT imaging scans, which were taken after anamnesis and clinical examinations. Because of the limitations of 2-dimensional radiographs, CT scanning is now considered the gold standard for diagnosing and classifying frontal bone fractures 9,29,30 . The axial, coronal, and sagittal views were used in this study to detect any fracture in the anterior and posterior walls of the frontal sinus and orbital cavity and assess the patency of the nasofrontal duct 24,31,32 …”

“…The information collected for each patient included age, sex, addictions, number of frontal sinuses, unilateral versus bilateral fracture, mechanism of injury (type of trauma), and classification of frontal sinus fracture. The age groups were defined as minors (0-17 y), young adults (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), adults (31-60), and the elderly (above 60). The mechanism of injury involved a car accident, motorcycle accident, falling, physical assault, and other forms of trauma, such as sports and work-related injuries.…”