Diagnostic efficacy of cone-beam computed tomography for mandibular fractures

Cone-Beam Computed Tomography (CBCT)-Based Diagnosis of Dental Bone Defects

Cone Beam Computed Tomography (CBCT) has completely changed the way that bone disorders are diagnosed and treated, especially in the dental and maxillofacial domains. This article examines the diverse applications of computed tomography (CBCT) in the diagnosis and treatment of facial trauma, including mandibular, dentoalveolar, and other facial fractures, as well as bone abnormalities like dislocations and fractures. CBCT is useful for a wide range of dental conditions and greatly improves diagnostic accuracy in periodontics, orthodontics, endodontics, and dental implantology. Additionally, a comparison between CBCT and conventional imaging methods was conducted, emphasizing the latter's inferior 3D imaging capabilities, allowing for more precise treatment planning and better patient outcomes with CBCT. Although CBCT has many benefits, it also has some drawbacks, such as requiring specific training for accurate interpretation, cost considerations, and a higher radiation exposure than with traditional dental X-rays. In order to optimize benefits and reduce risks, the conclusion highlights CBCT's revolutionary influence on clinical practice while arguing for its prudent and responsible application.

Influence of Method of Treatment of Mandibular Condylar Fractures on Range of Articular Path Measured by Cadiax Device

Background/Objectives: The aim of this study was to evaluate the function of the treated temporomandibular joint based on the analysis of the image of the articular path using the Cadiax device depending on the choice of treatment method for unilateral condylar fracture of the mandible. Methods: Sixty patients who were treated for condylar fractures of the mandible at the Maxil-lofacial Surgery Department in Katowice were qualified for the analysis of the range of movements of the mandibular heads using the Cadiax device. From the group of patients who suffered fractures of the mandible, including condylar processes, patients were finally qualified for the measurement of the articular path of the injured and healthy joint according to strict criteria. Results: The condylar examination was performed in 20 patients who had conservative condylar fracture treatment and 40 patients who underwent various surgeries in the course of a single condylar fracture. The control group consisted of 20 patients whose mean values for the articular pathway measured for both sides were 12.73 and 12.69 and fell within the standard developed for healthy joints tested with the Cadiax device. Conclusions: We have achieved an almost ideal treatment for condylar fractures. We are also beginning to notice the need for rehabilitation of patients after this type of surgery.

The comparison of visibility of the maxillary sinus septa between cone-beam computed tomography scans and panoramic radiograph images as dependent on the cortical bone thickness: a retrospective comparative study

PURPOSE

To analyze the visibility of the maxillary sinus septa (MSS) in panoramic radiography (PR) versus cone beam computed tomography (CBCT) and to investigate whether the buccal cortical bone thickness (BT) or the septa dimensions influence their visibility.

METHODS

Corresponding PR and CBCT images of 355 patients were selected and examined for MSS visibility. The septa dimensions (width, height, depth) and the BT were measured. Results were analysed statistically.

RESULTS

Comparing the corresponding regions on CBCT and PR, 170 MSS were identified; however, only 106 of these were also visible using PR. The MSS visibility was significantly higher on CBCT versus PR images (P1: p = 0.039, P2: p = 0.015, M1: p = 0.041, M2: p = 0.017, M3: p = 0.000), except region C (p = 0.625). Regarding the measurements of MSS dimensions, only the height in region M1 (p = 0.013) and the width in region P2 (p = 0.034) were significantly more visible on CBCT. The BT in the area of the MSS was found to have a marginal influence on its visibility on the PR images only in regions M3 and M1 (M3: p = 0.043, M1: p = 0.047). In terms of MSS visibility based on the dimensions, significance was found for all three influencing variables only in region P2 (width; p = 0.041, height; p = 0.001, depth; p = 0.007). There were only isolated cases of further significance: M3 for width (p = 0.043), M2 for height (p = 0.024), and P1 for depth (p = 0.034), no further significance was noted.

CONCLUSION

MSS visibility appears significantly higher on CBCT versus PR images. It is concluded that the septa dimensions and BT can influence MSS visibility on PR images just in certain regions.

The Application of Cone Beam Computed Tomography (CBCT) on the Diagnosis and Management of Maxillofacial Trauma

The assessment and management of facial trauma in an acute setting is one of the core services provided by oral and maxillofacial units in the United Kingdom. Imaging is a pre-requisite for appropriate diagnosis and treatment planning, with a combination of plain radiographs and medical-grade CT being the mainstay. However, the emergence of cone beam CT in recent years has led to its wider applications, including facial trauma assessment. It can offer multi-planar reformats and three-dimensional reconstruction at a much lower radiation dose and financial cost than conventional CT. The purpose of this review is to appraise its potential indications in all anatomical areas of maxillofacial trauma and provide our experience at a level 1 trauma centre.

Diagnostic performance of stitched and non-stitched cross-sectional cone-beam computed tomography images of a non-displaced fracture of ovine mandibular bone

Purpose

This study assessed the diagnostic performance of stitched and non-stitched cross-sectional cone-beam computed tomography (CBCT) images of non-displaced ovine mandibular fractures.

Materials and Methods

In this ex vivo study, non-displaced fractures were artificially created in 10 ovine mandibles (20 hemi-mandibles) using a hammer. The control group comprised 8 hemi-mandibles. The non-displaced fracture lines were oblique or vertical, <0.5 mm wide, 10-20 mm long, and only in the buccal or lingual cortex. Fracture lines in the ramus and posterior mandible were created to be at the interface or borders of the 2 stitched images. CBCT images were obtained from the specimens with an 80 mm × 80 mm field of view before and after fracture induction. OnDemand software (Cybermed, Seoul, Korea) was used for stitching the CBCT images. Four observers evaluated 56 (28 stitched and 28 non-stitched) images to detect fracture lines. The diagnostic performance of stitched and non-stitched images was assessed by calculating the area under the receiver operating characteristic curve (AUC). Sensitivity and specificity values were also calculated (alpha=0.05).

Results

The AUC was calculated to be 0.862 and 0.825 for the stitched and non-stitched images, respectively (P=0.747). The sensitivity and specificity were 90% and 75% for the non-stitched images and 85% and 87% for the stitched images, respectively. The inter-observer reliability was shown by a Fleiss kappa coefficient of 0.79, indicating good agreement.

Conclusion

No significant difference was found in the diagnostic performance of stitched and non-stitched cross-sectional CBCT images of non-displaced fractures of the ovine mandible.

Outcome of Management of Mandibular Sub condylar Fractures Based on Classification System Using Cone-Beam Computed Tomography

Purpose

The purpose of this study is to determine the amount of ramal height shortening and degree of displacement of sub condylar fracture that should be considered for effective management of mandibular sub condylar fractures using cone-beam computed tomography.

Patients and Methods

A prospective study of forty-two patients, who presented with unilateral sub condylar fracture was done. All patients were classified into Class I, II and III based on the degree of displacement of fractured segment and amount of ramal height shortening measured using cone-beam computed tomography. The treatment protocol was closed reduction and maxillomandibular fixation for Class I patients and open reduction and internal fixation for Class II and III patients. Outcomes of treatment were measured postoperatively 2 weeks, 1 and 3 months clinically. The variables, such as mouth opening, lateral and protrusive movements, deviation, pain and occlusion were studied.

Results

Among forty-two patients, twenty had Class I fractures, twelve had Class II fractures and ten had Class III fractures. Overall, no statistically significant differences were found between Class I and Class II groups in terms of functional outcomes and there were statistically significant differences between Class I and III groups. Class I fractures can be considered for closed method and open reduction is recommended for Class II and III fractures. The sample was composed of 42 patients grouped as follows: Class I (n = 20), Class II (n = 12), and Class III (n = 10) for treatment of sub condylar fractures. There were no significant differences between the three groups for the study variables at baseline, except for mouth opening and pain. There was significant difference in mouth opening between Class I and III cases (p 0.001) and insignificant difference in mouth opening in Class I and II cases (p 0.98). Persistent pain was elicited more in surgical Class II and III (n = 5) than non-surgical cases Class I (n = 0) on 3 months follow-up.

Conclusion

The study emphasises on use of three-dimensional diagnostic modality like cone-beam computed tomography for accurately classifying sub condylar fractures. The results favour closed reduction for mildly displaced Class I cases and surgical management of significantly displaced Class III fractures. The need for open reduction for Class II patients classified using CBCT is negligible assessing risks associated with surgical procedure which is contradictory to our protocol which requires a further comparative evaluation among Class II group.

Combined Deep Learning Techniques for Mandibular Fracture Diagnosis Assistance

Mandibular fractures are the most common fractures in dentistry. Since diagnosing a mandibular fracture is difficult when only panoramic radiographic images are used, most doctors use cone beam computed tomography (CBCT) to identify the patient's fracture location. In this study, considering the diagnosis of mandibular fractures using the combined deep learning technique, YOLO and U-Net were used as auxiliary diagnostic methods to detect the location of mandibular fractures based on panoramic images without CBCT. In a previous study, mandibular fracture diagnosis was performed using YOLO learning; in the detection performance result of the YOLOv4-based mandibular fracture diagnosis module, the precision score was approximately 97%, indicating that there was almost no misdiagnosis. In particular, fractures in the symphysis, body, angle, and ramus tend to be distributed in the middle of the mandible. Owing to the irregular fracture types and overlapping location information, the recall score was approximately 79%, which increased the detection of undiagnosed fractures. In many cases, fractures that are clearly visible to the human eye cannot be grasped. To overcome these shortcomings, the number of undiagnosed fractures can be reduced using a combination of the U-Net and YOLOv4 learning modules. U-Net is advantageous for the segmentation of fractures spread over a wide area because it performs semantic segmentation. Consequently, the undiagnosed case in the middle of the mandible, where YOLO was weak, was somewhat supplemented by the U-Net module. The precision score of the combined module was 95%, similar to that of the previous method, and the recall score improved to 87%, as the number of undiagnosed cases was reduced. Through this study, the performance of a deep learning method that can be used for the diagnosis of the mandibular bone has been improved, and it is anticipated that as an auxiliary diagnostic inspection device, it will assist dentists in making diagnoses.

Retrospective Evaluation of Maxillofacial Fractures With Cone-Beam Computed Tomography

ÖZ Amaç: Bu çalışmanın amacı maksillofasiyal bölgede meydana gelen fraktürlerin yaş ve cinsiyete göre dağılımlarını, lokalizasyonlarını, sayısını, deplasman varlığını, radyolojik özelliklerini Konik Işınlı Bilgisayarlı Tomografi (KIBT) ile retrospektif olarak değerlendirmektir. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Diş Hekimliği Fakültesi, Ağız Diş ve Çene Radyolojisi Anabilim Dalı’na 2019 ve 2021 yılları arasında travma nedeniyle başvuran 84 hastadan alınan KIBT görüntüleri retrospektif olarak incelenmiştir. Yaş, cinsiyet, fraktür lokalizasyonu, fraktürlerde deplasman varlığı kayıt altına alındı. İstatistiksel analiz için tüm hasta grubuna tanımlayıcı ve frekans analizleri uygulanırken, hastaların yaş ve cinsiyetlerini; fraktür hattı ve fraktür bölgesi ile karşılaştırırken ki-kare testi uygulandı. Bulgular: 60 erkek 24 kadın hasta (E/K, 2,5/1) olmak üzere toplam 84 hastanın maksillofasiyal travma nedeniyle KIBT görüntüsü incelendi. Çalışmada incelenen hasta grubunun yaşları 6 ve 72 arasında değişmekte olup yaş ortalaması 33.17±1.48 olarak belirlendi. Farklı etiyolojik nedenlerden kaynaklı çeşitli lokalizasyonlarda meydana gelen 116 fraktür hattı sayısı radyolojik olarak tespit edildi. İncelenen tüm fraktürlerin 73’ünde deplasman izlenirken kalan 43 fraktür hattında deplasman görülmedi. Meydana gelen fraktürler en sık angulus mandibulada (%22,61:n=19) tespit edildi. En az fraktür mandibula ramus (%3,57; n=3) ve koronoid proseste (%3,57; n=3) görüldü. Sonuçlar: Fraktür hatlarının varlığının, lokalizasyonlarının ve kırık parçalarının yer değişiminin doğru radyografik teknikler aracılığıyla tespit edilmesi, gerekli tedavi prosedürlerinin uygulanması açısından önem taşımaktadır. İki boyutlu radyografilerin kullanımının yetersiz kaldığı durumlarda KIBT gibi üç boyutlu görüntüleme yöntemleri tercih edilmelidir. Anahtar Kelimeler: Konik Işınlı Bilgisayarlı Tomografi, Fraktür, Mandibula, Teşhis

Re-evaluating the need for orthopantomography in the management of mandibular trauma: is computed tomography enough?

BACKGROUND

Mandibular fractures are frequent indications for computed tomography (CT) and orthopantomography (OPG) scans in emergency rooms. Numerous studies found CT to have higher sensitivity and enhanced accuracy compared to OPG in diagnosing mandible fractures. Controversy exists regarding additional need for OPG when evaluating dental trauma. This study investigates whether OPG adds diagnostic value to CT in mandibular trauma and whether additional OPG significantly alters management.

METHODS

A retrospective chart review identified 100 patients ≥ 18 years of age with known mandibular trauma who received CT and OPG in the emergency department between May 2015 and January 2020. All patients demonstrated a fracture in at least one study. CT and OPG studies were anonymized and randomized. A single attending surgeon evaluated mandible fracture and dental trauma characteristics and subsequently compared findings.

RESULTS

One hundred patient CT and OPG scans were reviewed. CT detected mandible fractures in all patients and OPG detected fractures in 93% (p = 0.01). Twenty-eight patients had different findings between scans. CT demonstrated 1 or more additional fracture(s) than OPG in 20 patients and dental trauma not seen on OPG in 4. OPG detected 1 fracture and no dental trauma that was not seen on CT. CT drove treatment-determining differences in 17 cases and OPG in 0 cases.

CONCLUSIONS

CT appears efficacious in detecting clinically significant mandible fractures and dental trauma with little additional benefit from OPG in emergency settings. Helical CT may be the only imaging necessary in evaluating patients with such trauma.

Radiological investigation of acute mandibular injury

This article focuses on the different imaging modalities used to evaluate acute mandibular fractures and explores important concepts relating to their diagnosis, investigation, and treatment. Significant focus will be given to exploring general management principles, considerations regarding first-line imaging, and recent technological advancement. Computed tomography (CT) is the preferred method when attempting to identify acute mandibular fractures, particularly in trauma patients, and has very high specificity and sensitivity. Multidetector CT now represents the standard of care, enabling fast scan times, reduced artifact, accurate reconstructed views, and three-dimensional (3D) reconstructions. Cone-beam CT is a newer advanced imaging modality that is increasingly being used worldwide, particularly in the ambulatory and intraoperative setting. It produces high-resolution images with submillimeter isotropic voxels, 3D and multiplanar reconstruction, and low radiation dose, however is less widely available and more expensive. Ultrasound is a valuable method in identifying a fracture in unstable patients, but is limited in its ability to detect nondisplaced fractures. Magnetic resonance imaging is useful in determining the presence of soft-tissue injury. CT angiography is invaluable in the assessment of potential vascular injury in condylar fracture dislocations.

Comparison of radiographical characteristics and diagnostic accuracy of intraosseous jaw lesions on panoramic radiographs and CBCT

OBJECTIVE

To investigate the differences in imaging characteristics and the diagnostic accuracy of 225 intraosseous jaw lesions on panoramic radiographs (PAN) versus cone beam computed tomography (CBCT).

METHODS

225 sets of PAN and CBCT images with biopsy-proven histopathological diagnoses were retrospectively compared in terms of radiographic features and diagnostic accuracy. The imaging characteristics of PAN and CBCT were independently evaluated by two oral and maxillofacial radiologists who were required to answer 12 questions and provided up to three differential diagnoses with their confidence scores.

RESULTS

Odds ratios (ORs) were statistically significant for border cortication (OR = 1.521; p = .003) and border continuity (OR = 0.421; p = .001), involvement on neurovascular canals (OR = 2.424; p < .001), expansion (OR = 7.948; p < .001), cortical thinning (OR = 20.480; p < .001) as well as its destruction (OR = 25.022; p < .001) and root resorption (OR = 2.477; p < .001). Furthermore, imaging features in the posterior and mandibular regions showed better agreement than those in the anterior and maxillary regions, respectively. The diagnostic accuracy of the first differential diagnosis was higher on CBCT than on PAN (Observer 1:78.7 vs 64.4%; Observer 2: 78.7 vs 70.2% (p < .001)). The observers' confidence scores were also higher at CBCT interpretation compared with PAN.

CONCLUSIONS

CBCT demonstrated a greater number of imaging characteristics of intraosseous jaw lesions compared with PAN, especially in the anterior regions of both jaws and in the maxilla. Diagnostic accuracy is improved with CBCT compared to PAN, especially for lesions in the maxilla. Radiologists have greater confidence when using CBCT.

Cone-beam computed tomography and its applications in dental and maxillofacial radiology

Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.

Imaging of mandibular fractures: a pictorial review

Mandibular fractures are among the most common maxillofacial fractures observed in emergency rooms and are mainly caused by road accidents. The clinical features of mandibular fractures include malocclusion and loss of mandibular function. Panoramic radiography is usually limited to isolated lesions, whereas computed tomography is the tool of choice for all other facial traumatic events. No reference standard classification system for the different types of mandibular fractures is defined. Therapeutic options include a conservative approach or surgical treatment based on the anatomic area and the severity of fracture. The main purpose of this pictorial review is to illustrate a practical description of the pathophysiology of mandibular fractures and describe both the imaging techniques to recognise them and the therapeutic indications.

Cone-beam computed tomography imaging of dentoalveolar and mandibular fractures

Three-dimensional imaging methods have an important role in the diagnosis of dentomaxillofacial fractures that can not be seen on the plain films. Cone-beam computed tomography (CBCT) is one of the three-dimensional imaging methods and has facilitated dental professionals' access to cross-sectional imaging. CBCT units allow different technical parameters and the data acquired by CBCT, can be reformatted. Osseous structures are correctly examined with this technique but the technique is not useful for the examination of soft tissues. Therefore, the purpose of its use should be based on the expected diagnostic gain. The aim of this review is to present the use of CBCT with different multi-planar reformatted sections and three-dimensional reconstructions of dentoalveolar and mandibular fractures.

Cone Beam Computed Tomography

In the last several decades, the need for 3D images in dentistry have developed. Computerized tomography was first introduced mainly with the advent of implantology, but its use remained limited to a small number of specialists, due to its indications, access and dose radiation. In the late 90's, a new technology using a cone-shaped beam and a reciprocating detector, which rotates around the patient 360 degrees and acquires projected data in a single rotation, namely the cone beam computerized tomography (CBCT), invaded dentistry, making the perception of 3D easily acceptable to dentists and their patients.

A Case of Medialized Lateral Maxillary Sinus Wall: A Pillar of Support

The number of maxillofacial trauma (MFT) cases attended in the Emergency Department is progressively increasing in trend, owing to the rising statistics of motor-vehicle accidents (MVAs) and urban assaults in addition to occupational-related injuries. Prompt and thorough assessment is important for accurate diagnosis and paramount treatment plans. We will be discussing a case of unusual presentation of an orbital floor fracture post-MVA which was treated conservatively based on the clinical assessments during follow-ups, supported by radiological findings. We will also briefly discuss the different radiological modalities available in assessing MFT and late presentation of enophthalmos.

Do CBCT scans alter surgical treatment plans? Comparison of preoperative surgical diagnosis using panoramic versus cone-beam CT images

Cone beam CT and/or panoramic images are often required for a successful diagnosis in oral and maxillofacial surgery. The aim of this study was to evaluate if 3D diagnostic imaging information had a significant impact on the decision process in six different classes of surgical indications.

MATERIAL AND METHODS

Records of all patients who had undergone both panoramic X-ray and CBCT imaging due to surgical indications between January 2008 and December 2012 were examined retrospectively. In February 2013, all surgically relevant diagnoses of both conventional panoramic radiographs and CBCT scans were retrieved from the patient's charts. It was recorded whether (1) 3D imaging presented additional surgically relevant information and (2) if the final decision of surgical therapy had been based on 2D or 3D imaging.

RESULTS

A total of 253 consecutive patients with both panoramic radiographs and CBCT analysis were eligible for the study. 3D imaging provided significantly more surgically relevant information in cases of implant dentistry, maxillary sinus diagnosis and in oral and maxillofacial traumatology. However, surgical strategies had not been influenced to any significant extent by 3D imaging.

CONCLUSION

Within the limitations of this study it may be concluded that CBCT imaging results in significantly more surgically relevant information in implant dentistry, maxillary sinus diagnosis and in cases of oral and maxillofacial trauma. However, 3D imaging information did not alter significantly the surgical plan that was based on 2D panoramic radiography. Further studies are necessary to define indications for CBCT in detail.

Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis

OBJECTIVES

The aims of this study were to evaluate whether the use of CT facilitates agreement among endodontists in selecting treatments for root-filled maxillary molars with apical periodontitis and to assess the efficacy of CT in choosing a treatment for such teeth.

METHODS

39 root-filled maxillary molars from 34 patients with suspected apical periodontitis were independently evaluated by 4 endodontists and 1 postgraduate student (decision-makers). Treatment decisions were made based on intra-oral radiographs and a fictive clinical history. After 1-3 months, the same decision-makers repeated the examination of the same teeth but with additional information from a CT examination. Agreement between decision-makers with or without the availability of the CT results was measured with Cohen's kappa coefficient. Differences in selected treatments with or without accessibility to the CT results were plotted for the same endodontists using descriptive statistics.

RESULTS

The agreement in assessments among endodontists was slight or fair before the CT results were available (range: 0.081-0.535). No increase was observed after reviewing the CT results (range: 0.116-0.379). After the use of CT, the treatment plan was changed 38-76% of the time by all decision-makers, and the changes affected 57.8% of the cases in the study.

CONCLUSIONS

The endodontists in this study exhibited a low degree of agreement when choosing a treatment for root-filled maxillary molars with apical periodontitis. A CT examination of the investigated teeth did not result in a significantly higher degree of agreement, and CT frequently contributed to a shift in the selected therapy.

Dentomaxillofacial imaging with panoramic views and cone beam CT

Panoramic and intraoral radiographs are the basic imaging modalities used in dentistry. Often they are the only imaging techniques required for delineation of dental anatomy or pathology. Panoramic radiography produces a single image of the maxilla, mandible, teeth, temporomandibular joints and maxillary sinuses. During the exposure the x-ray source and detector rotate synchronously around the patient producing a curved surface tomography. It can be supplemented with intraoral radiographs. However, these techniques give only a two-dimensional view of complicated three-dimensional (3D) structures. As in the other fields of imaging also dentomaxillofacial imaging has moved towards 3D imaging. Since the late 1990s cone beam computed tomography (CBCT) devices have been designed specifically for dentomaxillofacial imaging, allowing accurate 3D imaging of hard tissues with a lower radiation dose, lower cost and easier availability for dentists when compared with multislice CT. Panoramic and intraoral radiographies are still the basic imaging methods in dentistry. CBCT should be used in more demanding cases. In this review the anatomy with the panoramic view will be presented as well as the benefits of the CBCT technique in comparison to the panoramic technique with some examples. Also the basics as well as common errors and pitfalls of these techniques will be discussed. Teaching Points • Panoramic and intraoral radiographs are the basic imaging methods in dentomaxillofacial radiology.• CBCT imaging allows accurate 3D imaging of hard tissues.• CBCT offers lower costs and a smaller size and radiation dose compared with MSCT.• The disadvantages of CBCT imaging are poor soft tissue contrast and artefacts.• The Sedentexct project has developed evidence-based guidelines on the use of CBCT in dentistry.

Clinical utility of dental cone-beam computed tomography: current perspectives

Panoramic radiography and computed tomography were the pillars of maxillofacial diagnosis. With the advent of cone-beam computed tomography, dental practice has seen a paradigm shift. This review article highlights the potential applications of cone-beam computed tomography in the fields of dental implantology and forensic dentistry, and its limitations in maxillofacial diagnosis.

Analysis of mandibular condylar and glenoid fossa fractures with computed tomography

OBJECTIVES

The purpose of this study was to investigate the prevalence of glenoid fossa and condylar fractures in patients with mandibular fractures using multidetector computed tomography (MDCT).

METHODS

A prospective study was performed in 227 patients with mandibular fractures who underwent 64-MDCT. Mandibular fractures were classified into four types: median, paramedian, angle and condylar. Statistical analysis of the relationship between prevalence of condylar fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P value less than 0.05 was considered statistically significant.

RESULTS

The prevalence of condylar fracture was 64.8 % of all patients with mandibular fractures, 66.7 % of median type (P = 0.667), 45.5 % of paramedian type (P = 0.001) and 12.3 % of angle type (P = 0.000), respectively. Furthermore, glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures.

CONCLUSIONS

The results of the presented study suggest focusing also on incidental findings such as glenoid fossa fractures.

KEY POINTS

• The prevalence of condylar fracture was 64.8 % in patients with mandibular fractures. • Glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures. • The study suggests a focus on incidental findings such as glenoid fossa fractures.

Mandibular fracture patterns consistent with posterior maxillary fractures involving the posterior maxillary sinus, pterygoid plate or both: CT characteristics

OBJECTIVES

The aim of this study was to determine the incidence of posterior maxillary fractures involving the posterior maxillary sinus wall, pterygoid plate or both, unrelated to major midface fractures in patients with mandibular fractures, and to characterize associated fractures.

METHODS

A CT study was performed in patients with mandibular fractures to identify posterior maxillary fractures. Patients aged under 16 years, those with mandibular fractures involving only dentoalveolar components and those with concurrent major midfacial fractures were excluded.

RESULTS

13 (6.7%) of 194 patients with mandibular fractures also had posterior maxillary fractures (case group). The injury pattern correlated with the external force directed to the lateral side of the mandible (p < 0.001), alcohol consumption (p = 0.049), the presence of multifocal fractures (p = 0.002) and the fracture regions in the symphysis/parasymphysis (p = 0.001) and the angle/ramus (p = 0.001). No significant difference between the case and non-case groups was seen for age, sex or cause of trauma. Non-displaced fractures in the ipsilateral posterior mandible occurred with significant frequency (p = 0.001) when the posterior maxillary fractures involved only the sinus.

CONCLUSIONS

Mandibular fractures accompanied by posterior maxillary fractures are not rare. The finding of a unilateral posterior maxillary fracture on CT may aid the efficient radiological examination of the mandible based on possible patterns of associated fractures, as follows: in the ipsilateral posterior region as a direct fracture when the impact is a medially directed force, and in the symphysis/parasymphysis or contralateral condylar neck as an indirect fracture.