The Identification of Mandible Fractures by Helical Computed Tomography and Panorex Tomography

Abstract

The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.

A chilling reminder: Pediatric facial trauma from recreational winter activities

“…3). Although improvement in imaging technologies has led Computed Tomography to surpass plain films (panorex) for the diagnosis of many mandible fractures [43], the relationship of CT radiation exposure with the risk of childhood cancer remains controversial [44,45]. As plain film panorex studies represent an acceptable alternative to CT and mandible fractures comprised only 11% fractures (and only 0.6% of total pediatric facial injuries from winter sports), these findings discourage the use of CT among this population unless there is a strong index of suspicion for mid-face fracture.…”

Incidence and Characterization of Unifocal Mandible Fractures on CT

“…Helical CT has been reported to be more accurate, sensitive, and specific for the diagnosis of mandibular fractures (particularly in the posterior portions of the mandible) and to have better interobserver agreement and fracture characterization than panoramic tomography. 2,5 Thus, the true incidence of multifocality might be higher than that reported in the literature, which is based on studies in which all patients did not receive dedicated facial bone CT scans. The purpose of this study was to determine the incidence of unifocal mandible fractures on the basis of detection with dedicated facial bone CT scans and to characterize these fractures.…”

“…The mandible is the second most frequently fractured bone in the facial skeleton, and in the setting of motor vehicle crashes, mandible fractures are the most frequent. 1,2 Fractures of the mandible at multiple sites are common and should always be sought radiographically. 1 Conventional thinking among radiologists holds that the mandible, when considered along with the central skull base, is a closed ring that needs to fracture at 2 points.…”

Quantification by Quadrants of the Distortion Present in Conventional Panoramic Radiograph

“…With this type of X-ray it is possible to identify and study specific anatomic structures, among these the location of the mandibular canal in relation to the third molars (Sedaghatfar, 2005), the mental foramen (Mohamed et al, 2016), and the position of the teeth (Sandhu & Kaur, 2008). It serves to evaluate alterations caused by missing or supernumerary teeth, alterations in the dental morphology, bone alterations like osteonecrosis (Treister et al, 2009) and osteoporosis (Gaur et al, 2013), bone fractures (Roth et al, 2005), facial asymmetries (Farman, 2006), and dental-facial anomalies. It is also useful for corpse identification (Tohnak, 2007) and for predicting gender and age (Bhardwaj et al, 2014).…”