Title: Multidetector Computed Tomographic Evaluation of Patterns of Facial Bone Fractures
Authors: Dr Gomathiponshankar Ilayappan, Prof. Dr Adaikkappan M
DOI: https://dx.doi.org/10.18535/jmscr/v6i10.92
Abstract
With the increasing numbers of road traffic accidents and violence, Facial injuries causing fracture have become common any emergency department. Multidetector computed tomography (MDCT) is the best choice for imaging facial bones in an emergency setting. The
Objectives: 1. To study the efficacy of axial images in comparison with Coronal and 3 Dimensional CT reformatted images in detection of patterns of fracture in maxillofacial injuries. 2. To asses, the number of fractures, fracture extent and displacement of fracture fragments by comparing axial images with coronal and 3D images 3. To know about the prevalence of maxillofacial injuries. 4. To describe and classify the facial fractures.
Materials and Methods: Our study population consisted of 140 patients with facial bone fractures who came to the emergency department of RMMCH. CT scan of facial bones was taken on the advice of the casualty medical officer and images were acquired using Alexion 4-Slice CT (Toshiba) scanner using analyzed at the CT console. 3D images were compared with axial images and scoring was made under the following headings – Fracture Detection, Extent of fracture and Displacement of fracture fragments. Axial and Coronal images were compared in terms of the detection of the fracture.
Results: Our study group which comprised of a total of 140 patients, and the age at presentation was from 01 to 80 yrs. The Zygoma was the frequently involved bone followed in frequency by the frontal region fractures. The maxillary fractures were the affected region with fractures detected in 70 % of patients. Naso-orbito-ethmoid and mandibular fractures were detected in 52 and 43 % of patients.
Conclusion: The 3D images are useful in the facial trauma, particularly in case of mandibular and zygomatic fracture. Frontal and maxillary bone fractures were detected easily using 3D and their displacement pattern in patients with complex midface region fractures could be easily described. Le Fort type fracture was better identified in the 3D study. The coronal reconstruction helped in the detection of fractures involving the maxilla and medial wall and floor of the orbit. Naso-orbito-ethmoid region fractures were less detected and were not informative on 3 D images. Minimal fracture displacement was also less detected on 3D reformats.
Keywords: 3Dimages, Computed tomography, Fracture, Naso-orbito-ethmoid, Le Fort;
References
- Turner BG, Rhea JT, Thrall JH, Small AB, Novelline RA. Trends in the use of CT and radiography in the evaluation of facial trauma, 1992-2002: implications for current costs. Am J Roentgenol 2004;183:751-754
- Tanrikula R, Erol B. Comparison of CT with conventional radiography for mid facial fractures. Dentomaxillofacial radiology 2001; 30:141-146.
- Taguchi K, Anno H, High temporal resolution for multislice helical computed tomography. Med Phys 2000; 27:1861-72.
- Flohr T, Stierstorfer K, Bruder H, Simon J, Polacin A, Schaller S. Image reconstruction and image quality evaluation for a 16-slice CT scanner. Med Phys 2003; 30:832-45.
- Solonen EM, Koivikko MP, Koskinen SK. Multidetector CT imaging of facial trauma in accident falls from heights. Acta Radiologica 2007; 4: 449-455.
- Adi M, Ogden GR, Chisholm DM: An analysis of mandibular fractures in Dundee, Scotland (1977-1985). Br J Oral Maxillofacial Surgery 1990; 28: 194-9.
- Jaber MA, Porter SA: Maxillofacial injuries in 109 Libyan children under 13 years of ages. Int J Fediatr Dent 1997;7:39-40.
- Fox LA, Vannier MW, West OC, Wilson AJ, Baran GA, Pilgarm TK. Diagnostic performance of CT, MPR and 3DCT imaging in maxillofacial trauma. Comput Med Imaging Graph 1995;19:385-395.
- Dos Santos DT, Costa e Silve AP, Vannier MW, Cavalcanti MG. Validity of multislice computerized tomography for diagnosis of maxillofacial fractures using an independent workstation. Oral Sur Oral Med Oral Path Oral Radio Endod 2004; 98:715-720.
- Hessel A, Roebuck JC, Perierea KD, Poole MD. 3D computed tomography reconstru-ction alter management decisions of facial fractures. Otolaryngol Head Neck Surg 2004;131:243.
- Klenk G, Kovacs A. Do we need three-dimensional computed tomography in maxillofacial surgery. J Craniofac surg 2004;15:842850.
- Buitrago-Te„llez CH, Schilli W, Bohnert M, Alt K, Kimmig M. Acomprehensive classification of craniofacial fractures: postmorterm and clinical studies with two- and three-dimensional computed tomography Injury 2002; 33:651-68
- Cavalcanti MGP, Haller JW, Vannier MW. Three-dimensional computed tomography landmark measurement in craniofacial surgicall planning: experimental validation in vitro. J Oral Maxillofac Surg 1999;57:690-4.
- Noyek A, Kasel EE. Contempory radiological evaluation of maxillofacial trauma. Otolaryngol Clin North Am 1983;16:473-512.
- Hall RK, Thomas C. Ten years of traumatic injury to the face and jaw; a computer analysis. Eighth International Conference on Oral Surgery, Berlin, 1982.
- Levoy M. Display of surfaces from volume data. IEEE Comput Graph Appl 1988;8:29-37.
- Kruger GO Textbook of Oral and Maxillofacial Surgery. St Louis, C.V. Mosby Co., 1984, p378.
- Duval AJ, Benovitz JD. Maxillary fractures. Otolaryngology Clin North Am 1976;9:498-98.
- Bagheri SC, Holmgren E, Kademani D, Hommer L, Bell RB, Potter BE, et al. Comparison of the severity of bilateral Le Fort injuries in isolated mid facial trauma. Oral Maxillofacial Surgery 2005;63:1123-9.
- Sivalingam J, Kumar VA, Yennabathina K, et al .Evaluation of Maxillofacial Injuries Using Multislice Computed Tomography. IOSR Journal of Dental and Medical Sciences .2016;15:11p49 57.