Imaging in traumatic mandibular fractures

Abstract

A fracture of the mandible is a common trauma presentation amongst young males and represents one of the most frequently encountered fractured bones within the viscerocranium. Historically, assault was the dominant contributing factor but now due to the increased number of vehicles used per capita, motor vehicle accidents are the primary cause. Mandibular fractures can be classified anatomically, by dentition, by muscle group and by severity. The fracture may also be closed, open, comminuted, displaced or pathological. It is important that the imaging modality used identifies the classification as this will decide definitive treatment. X-ray projections have typically been used to detect a mandibular fracture, but are limited to an anteroposterior (AP), lateral and oblique view in an unstable trauma patient. These views are inadequate to detail the level of fracture displacement and show poor detail of the condylar region. Computer tomography (CT) is the imaging modality of choice when assessing a traumatic mandibular injury and can demonstrate a 100% sensitivity in detecting a fracture. This is through use of a multidetector-row CT, which reduces motion blur and therefore produces accurate coronal and sagittal reconstructions. Furthermore, reconstructive three-dimensional CT images gained from planar views, allows a better understanding of the spatial relationship of the fracture with other anatomical landmarks. This ensures a better appreciation of the severity and classification of a mandibular fracture, which therefore influences operative planning. Ultrasound is another useful modality in detecting a mandibular fracture when the patient is too unstable to be transferred to a CT scanner. The sensitivity however is less in comparison to a CT series of images and provides limited detail on the fracture pattern. Magnetic resonance imaging demonstrates use in assessing soft tissue injury of the temporomandibular joint but this is unlikely to be of priority when initially assessing a trauma patient.

Imaging of mandibular fractures: a pictorial review

“…Panoramic radiography (PAN) is a zonography of upper and lower jaws. It has much higher sensitivity than the three aforementioned X-ray view series for the detection of mandibular fractures (70-92% and 66%, respectively) [1,8]. Unfortunately, both PAN and X-ray views are affected by the typical disadvantages of two-dimensional imaging [9]-difficulty in the patient's positioning, anatomic noise, superimposition, geometric distortion, X-ray angulations, and radiographic contrast-and may be burdened by the slight movements of the mandible, resulting in artefacts.…”

“…Multislice spiral computed tomography (MSCT) represents the reference survey in complex fractures because it benefits from thin-layer thicknesses (0.5-1.0 mm), native images, and three-dimensional multiplanar reformat reconstructions with no overlap between the different anatomic structures. MSCT has sensitivity around 100% in the detection of mandibular fractures [1].…”

“…Mandibular fractures are among the most common (60-70%) maxillofacial fractures observed in emergency rooms [1]; more than 2,500 people suffer a mandibular fracture every year in the USA [2]. The epidemiology of maxillofacial fractures varies according to geographical areas and socio-economic factors.…”

Synovial Chondromatosis of the Temporomandibular Joint Misdiagnosed as Avulsion Fracture of Condylar Process of the Mandible: A Case Report

“…Post-traumatic fracture could be another differential diagnosis of SC and degenerative joint disease, as in our case, but should be associated with a stronger clinical link. In this report, the first imaging examination was via US, which is not the best investigation choice after a traumatic event [10]. The overall advantages of US consist in the rapid imaging examination procedure, with a relatively modest cost and does not require usage of ionizing radiation.…”

<b>Risk Assessment for Condylar Fracture Using Classification of the Mandibular Inferior Cortical Shape by Pantomography </b>

“…A fracture of the mandible is a common trauma presentation and represents one of the most frequently encountered fractured bones within the viscerocranium (3). Patients suffering from mandibular fractures are confronted with several problems that may have a significant impact on their health-related quality of life including changes in facial appearance, impaired oral and masticatory functions, sensory disturbances, obstacles in daily routines, and interruption of social and working life due to convalescence (4).…”