RADIGRAPHIC EXAMINATION IN MAXILLOFACIAL TRAUMA

Radiological examination

Useful diagnostic aid.

Radiation cost

Financial cost

Urgency of the treatment.

Projections for facial fractures

For fractures of middle third of the face

- Occipitomental view

- Submentovertex view

- Lateral skull

- PA view – water’s position

For zygomatic complex fracture

- Occipitomental view

- Submentovertex view

- PA view – water’s position

For mandibular fractures

- OPG

- Right & left lateral oblique view of

mandible

- PA view of mandible

Radiological interpretation of

facial trauma

You see what you look for…!!!!

Occipitomental projection

Fractures & other signs are

commonly found.

Campbell’s and trapnell’s lines

Dolan & Jacoby’s line

A) Orbital line.

B) Zygomatic line.

C) Maxillary line.

4 ‘S’ by Delbalso et al

Symmetry.

Sharpness – Bright sign, Trapdoor sign.

Sinus.

Soft tissues.

foreign bodies, emphysema.

HOT sites of fracture on

face.

Radiographic signs of fracture.

Separation sign.

Sutural diastasis.

Overlap sign.

Abnormal linear density

Disappearing fragment sign.

Abnormal angulation.

Step deformity

Indirect signs.

Soft tissue swelling.

localized – attention to that part

Paranasal sinus opacification.

Air in the soft tissues.

CT scan

Provides images in thin slices,

avoid superimposition of

structures.

Increased contrast- foreign

bodies.

Axial CT scan – transverse

plane.

Coronal CT scan – orbital

examination

MRI- soft tissue injury, CSF leak.

Recent advances

Spiral & Multislice CT

- Much faster & can provide 9 times larger image.

- High quality reconstruction.

3D CT scan.

Angiography, arthrography.

Conclusion.

Surgical outcome

Treatment planning

Accurate diagnosis

Careful clinical examination

References.

Oral & maxillofacial trauma- Fonseca,vol 1

Maxillofacial Injuries- Rowe & Williams

Textbook of oral & maxillofacial surgery by Peter

Ward Booth.