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.

Enophthalmos and Orbital Volume Changes in Zygomaticomaxillary Complex Fractures: Is There a Correlation Between Them?

“…After comparing conventional 2D radiographs with CT scans, Shah et al 26 reported that CT scan considerably increased the surgeon's ability to diagnose ZMC, zygomatic arch, and inferior orbital floor fractures. The CT scan seems to be a precise method for the detection of fracture, soft tissue involvement, and ocular position.…”

“…The CT scan seems to be a precise method for the detection of fracture, soft tissue involvement, and ocular position. 7,26 In the present study, 3D reconstruction and volume measurements were performed with the aid of Mimics software. This biomedical engineering software can be used for 3D reconstruction and anthropometric analysis.…”

Feasibility of three-dimensional CT reconstruction in assessing mandibular fractures

“…According to these authors, visualization in three dimensions helps the complex process in which the surgeon visualizes operational planning 4 . This advantage is also pointed out in the clinical trial by Shah et al 11 . Perandini, et al 12 who reinforce in their articles the importance of 3D-CT in the diagnosis of relatively common conditions such as thrombosis, stenosis of the airways, exophytic cancer and trauma.…”

The Effectiveness of Routine Cranial Computerized Tomography in the Evaluation of Facial Bone Fractures

“…Therefore, fractures involving the maxillary sinus are frequently accurately identified. Shah et al (6) investigated the efficacy of three-dimensional computed tomography in the diagnosis of maxillofacial fractures. They compared their study findings with those of Baek et al (11) and attributed the resulting discrepancies in the determination of undisplaced fractures to slice thickness (6).…”

“…Shah et al (6) investigated the efficacy of three-dimensional computed tomography in the diagnosis of maxillofacial fractures. They compared their study findings with those of Baek et al (11) and attributed the resulting discrepancies in the determination of undisplaced fractures to slice thickness (6). We were unable to identify seven of the maxillary fractures, though inside the cranial CT imaging field, these were undisplaced in character.…”