1
|
Sheng K. Radiological investigation of acute mandibular injury. Natl J Maxillofac Surg 2022; 13:165-171. [PMID: 36051802 PMCID: PMC9426694 DOI: 10.4103/njms.njms_27_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/15/2019] [Accepted: 01/09/2020] [Indexed: 12/04/2022] Open
Abstract
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.
Collapse
|
5
|
Dreizin D, Nam AJ, Tirada N, Levin MD, Stein DM, Bodanapally UK, Mirvis SE, Munera F. Multidetector CT of Mandibular Fractures, Reductions, and Complications: A Clinically Relevant Primer for the Radiologist. Radiographics 2017; 36:1539-64. [PMID: 27618328 DOI: 10.1148/rg.2016150218] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
After the nasal bones, the mandible is the second most common site of facial fractures, and mandibular fractures frequently require open reduction. In the trauma injury setting, multidetector computed tomography (CT) has become the cornerstone imaging modality for determining the most appropriate treatment management, fixation method, and surgical approach. Multidetector CT is also used to assess the adequacy of the reduction and evaluate potential complications in the postoperative period. For successful restoration of the mandible's form and function, as well as management of posttraumatic and postoperative complications, reconstructive surgeons are required to have a detailed understanding of mandibular biomechanics, occlusion, and anatomy. To provide added value in the diagnosis, treatment planning, and follow-up of mandibular fractures, radiologists should be aware of these concepts. Knowledge of the techniques commonly used to achieve occlusal and anatomic reduction and of the rationale behind the range of available treatment options for different injury patterns-from isolated and nondisplaced fractures to multisite and comminuted fractures-also is essential. This article focuses on the use of multidetector CT for pre- and postoperative evaluation of mandibular fractures and outlines fundamental concepts of diagnosis and management-beginning with an explanation of common fracture patterns and their biomechanical underpinnings, and followed by a review of the common postoperative appearances of these fractures after semirigid and rigid fixation procedures. Specific considerations regarding fractures in different regions of the tooth-bearing and non-tooth-bearing mandible and the unique issues pertaining to the edentulous atrophic mandible are reviewed, and key features that distinguish major from minor complications are described. (©)RSNA, 2016.
Collapse
Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Arthur J Nam
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Nikki Tirada
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Martin D Levin
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Deborah M Stein
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Uttam K Bodanapally
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Stuart E Mirvis
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| | - Felipe Munera
- From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., U.K.B., S.E.M.), Division of Plastic Surgery (A.J.N.), and Department of Surgery (D.M.S.), University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, The George Washington Hospital, Washington, DC (N.T.); School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa (M.D.L.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine and Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.)
| |
Collapse
|
6
|
Johari M, Ghavimi MA, Mahmoudian H, Javadrashid R, Mirakhor Samani S, Fouladi DF. A comparable study of the diagnostic performance of orbital ultrasonography and CBCT in patients with suspected orbital floor fractures. Dentomaxillofac Radiol 2016; 45:20150311. [PMID: 27074346 DOI: 10.1259/dmfr.20150311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: To compare the diagnostic performance of ultrasonography and CBCT against CT in detecting orbital floor fractures. METHODS: A total of 120 orbits with clinical suspicion of isolated orbital floor fractures underwent multislice CT scanning with coronal reconstruction; orbital ultrasonography using a standard machine equipped with a 7- to 10-MHz linear transducer; and CBCT. Patients with severe head and face injuries were not included. The diagnostic performance of ultrasonography and CBCT was reported assuming conventional CT as the imaging method of choice. RESULTS: According to CT findings, fractures of the floor were present in 39 orbits. The sensitivity, specificity, positive-predictive value and negative-predictive value of ultrasonography in detecting orbital floor fractures were 87.2%, 100%, 100% and 94.2%, respectively. The corresponding values for CBCT were 97.4%, 97.5%, 95.0%, and 98.8%, respectively. Areas under the receiver operator characteristics curves of orbital floor fracture detection were 0.94 for ultrasonography and 0.98 for CBCT. CONCLUSIONS: When conventional CT cannot be performed in patients with clinically suspected orbital floor fracture and no severe or complex head and face injuries, CBCT could be used in detecting fractures as a reliable surrogate. Because of a lower sensitivity of ultrasonography, however, its use is limited in this regard.
Collapse
Affiliation(s)
- Masoumeh Johari
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Mohammad Ali Ghavimi
- 2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Hediyeh Mahmoudian
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Reza Javadrashid
- 3 Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Simin Mirakhor Samani
- 4 Department of Pathology, Qazvin University of Medical Sciences, Qazvin, Islamic Republic of Iran
| | - Daniel F Fouladi
- 5 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| |
Collapse
|