Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
권호 표지

Diagnostic ability of panoramic radiography for mandibular fractures

하악골 골절에 대한 파노라마방사선사진의 진단능

  • Lee, Ji-Hyun (Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University) ;
  • Jung, Yun-Hoa (Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University) ;
  • Cho, Bong-Hae (Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University) ;
  • Hwang, Dae-Seok (Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University)
  • 이지현 (부산대학교 치의학전문대학원 구강악안면방사선학교실) ;
  • 정연화 (부산대학교 치의학전문대학원 구강악안면방사선학교실) ;
  • 조봉혜 (부산대학교 치의학전문대학원 구강악안면방사선학교실) ;
  • 황대석 (부산대학교 치의학전문대학원 구강악안면외과학교실)
  • Received : 2009.12.17
  • Accepted : 2010.01.14
  • Published : 2010.03.31
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Abstract

Purpose : The purpose of this study was to evaluate the diagnostic efficacy of panoramic radiographs for detection of mandibular fractures. Materials and Methods : The sample was comprised of 65 patients (55 fractured, 10 non-fractured) with 92 fracture sites confirmed by multi-detector computed tomography (CT). Panoramic radiographs were evaluated for mandibular fractures by six examiners; two oral & maxillofacial radiologists (observer A&B), two oral & maxillofacial surgeons (observer C&D), and two general dentists (observer E&F). Results : Sensitivity of panoramic radiography for mandibular fractures was 95.7% in observer A&B, 93.5% in observer C&D and 80.4% in observer E&F. The lowest sensitivity was shown in symphyseal/parasymphyseal areas, followed by subcondylar/condylar regions. Conclusion : Panoramic radiography is adequate for detection of mandibular fractures. However, additional multidetector CT is recommended to ascertain some indecisive fractures of symphysis and condyle, and in complicated fractures.

Keywords

References

  1. Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990; 48 : 926-32. https://doi.org/10.1016/0278-2391(90)90004-L
  2. King RE, Scianna JM, Petruzzelli GJ. Mandible fracture patterns: a suburban trauma center experience. Am J Otolaryngol 2004; 25 : 301- 7. https://doi.org/10.1016/j.amjoto.2004.03.001
  3. Lee JK, Kim SK. Clinical study on current jaw fractures of Koreans. J Kor Oral Maxillofac Surg 1994; 20 : 294-304.
  4. Reiner SA, Schwartz DL, Clark KF, Markowitz NR. Accurate radiographic evaluation of mandibular fractures. Arch Otolaryngol Head Neck Surg 1989; 115 : 1083-5. https://doi.org/10.1001/archotol.1989.01860330073020
  5. Chayra GA, Meador LR, Laskin DM. Comparison of panoramic and standard radiographs for the diagnosis of mandibular fractures. J Oral Maxillofac Surg 1986; 44 : 677-9. https://doi.org/10.1016/0278-2391(86)90034-0
  6. Markowitz BL, Sinow JD, Kawamoto HK Jr, Shewmake K, Khoumehr F. Prospective comparison of axial computed tomography and standard and panoramic radiographs in the diagnosis of mandibular fractures. Ann Plast Surg 1999; 42 : 163-9. https://doi.org/10.1097/00000637-199902000-00010
  7. Salvolini U. Traumatic injuries: imaging of facial injuries. Eur Radiol 2002; 12 : 1253-61. https://doi.org/10.1007/s00330-002-1445-8
  8. Thai KN, Hummel RP 3rd, Kitzmiller WJ, Luchette FA. The role of computed tomographic scanning in the management of facial trauma. J Trauma 1997; 43 : 214-7; discussion 217-8. https://doi.org/10.1097/00005373-199708000-00002
  9. Giovannini UM, Goudot P. Radiologic evaluation of mandibular and dentoalveolar fractures. Plast Reconstr Surg 2002; 109 : 2165-6.
  10. Lee SJ, Kim HC, Bae SH, Yoon DY, Choi MH, Kim YC. Diagnostic accuracy and usefulness of three dimensional image of helical CT in maxillofacial fractures. Kor J Radiol 1997; 36 : 575-8. https://doi.org/10.3348/jkrs.1997.36.4.575
  11. Roth FS, Kokoska MS, Awwad EE, Martin DS, Olson GT, Hollier LH, et al. The identification of mandible fractures by helical computed tomography and panorex tomography. J Craniofac Surg 2005; 16 : 394-9. https://doi.org/10.1097/01.scs.0000171964.01616.a8
  12. Wilson IF, Lokeh A, Benjamin CI, Hilger PA, Hamlar DD, Ondrey FG, et al. Prospective comparison of panoramic tomography (zonography) and helical computed tomography in the diagnosis and operative management of mandibular fractures. Plast Reconstr Surg 2001; 107 : 1369- 75. https://doi.org/10.1097/00006534-200105000-00008
  13. Oikarinen KS. Clinical management of injuries to the maxilla, mandible, and alveolus. Dent Clin North Am 1995; 39 : 113-31.
  14. Moilanen A. Midfacial fractures in dental panoramic radiography. Oral Surg Oral Med Oral Pathol 1984; 57 : 106-10. https://doi.org/10.1016/0030-4220(84)90270-6
  15. Nair MK, Nair UP. Imaging of mandibular trauma: ROC analysis. Acad Emerg Med 2001; 8 : 689-95. https://doi.org/10.1111/j.1553-2712.2001.tb00186.x
  16. Johnston CC, Doris PE. Clinical trial of pantomography for the evaluation of mandibular trauma. Ann Emerg Med 1980; 9 : 415-8. https://doi.org/10.1016/S0196-0644(80)80154-5
  17. Chang SH, Ann JJ, Soh JJ. Accurate radiographic evaluation of mandibular fractures. J Kor Oral Maxillofac Surg 1990; 16 : 12-5.
  18. Wilson IF, Lokeh A, Benjamin CI, Hilger PA, Hamlar DD, Ondrey FG, et al. Contribution of conventional axial computed tomography (nonhelical), in conjunction with panoramic tomography (zonography), in evaluating mandibular fractures. Ann Plast Surg 2000; 45 : 415-21. https://doi.org/10.1097/00000637-200045040-00011
  19. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Measurement 1960; 20 : 37-46. https://doi.org/10.1177/001316446002000104
  20. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 : 159-74. https://doi.org/10.2307/2529310
  21. Creasman CN, Markowitz BL, Kawamoto HK Jr, Cohen S, Kioumehr F, Hanafee WN, et al. Computed tomography versus standard radiography in the assessment of fractures of the mandible. Ann Plast Surg 1992; 29 : 109-13. https://doi.org/10.1097/00000637-199208000-00002
  22. Brink JA. Technical aspects of helical (spiral) CT. Radiol Clin North Am 1995; 33 : 825-41.
  23. Schuknecht B, Graetz K. Eur Radiol. Radiologic assessment of maxillofacial, mandibular, and skull base trauma. Eur Radiol 2005; 15 : 560-8. https://doi.org/10.1007/s00330-004-2631-7
  24. Luyk NH, Ferguson JW. Fractures of the mandible: role of the general dentist. N Z Dent J 1992; 88 : 46-51.
  25. Buitrago-Téllez CH, Audige L, Strong B, Gawelin P, Hirsch J, Ehrenfeld M, et al. A comprehensive classification of mandibular fractures: a preliminary agreement validation study. Int J Oral Maxillofac Surg 2008; 37 : 1080-8. https://doi.org/10.1016/j.ijom.2008.06.008
  26. Escott EJ, Branstetter BF. Incidence and characterization of unifocal mandible fractures on CT. AJNR Am J Neuroradiol 2008; 29 : 890-4. https://doi.org/10.3174/ajnr.A0973
  27. Greene D, Raven R, Carvalho G, Maas CS. Epidemiology of facial injury in blunt assault. Determinants of incidence and outcome in 802 patients. Arch Otolaryngol Head Neck Surg 1997; 123 : 923-8. https://doi.org/10.1001/archotol.1997.01900090029005
  28. Rhea JT, Rao PM, Novelline RA. Helical CT and three-dimensional CT of facial and orbital injury. Radiol Clin North Am 1999; 37 : 489- 513. https://doi.org/10.1016/S0033-8389(05)70108-1
  29. Kim JW, Koh KJ. Radiological study of the mandibular fractures. Kor J Oral & Maxillofac Radiol 2009; 39 : 93-8.
  30. Assael LA. Clinical aspects of imaging in maxillofacial trauma. Radiol Clin North Am 1993; 31 : 209-20.
  31. Chacon GE, Dawson KH, Myall RW, Beirne OR. A comparative study of 2 imaging techniques for the diagnosis of condylar fractures in children. J Oral Maxillofac Surg 2003; 61 : 668-72; discussion 673. https://doi.org/10.1053/joms.2003.50134
  32. Romeo A, Pinto A, Cappabianca S, Scaglione M, Brunese L. Role of multidetector row computed tomography in the management of mandible traumatic lesions. Semin Ultrasound CT MR 2009; 30 : 174-80. https://doi.org/10.1053/j.sult.2009.02.008
  33. Shetty V, Atchison K, Belin TR, Wang J. Clinician variability in characterizing mandible fractures. J Oral Maxillofac Surg 2001; 59 : 254- 61; discussion 261-2. https://doi.org/10.1053/joms.2001.20984