title: Diagnostic accuracy of maxillofacial trauma two-dimensional and three-dimensional computed tomographic scans: comparison of oral surgeons, head and neck surgeons, plastic surgeons, and neuroradiologists.
abstract: BACKGROUND
  The authors' objectives were to study differences in diagnostic accuracy between two- and three-dimensional computed tomographic scans and among the specialties of plastic surgery, head and neck surgery, oral surgery, and neuroradiology, since this had not previously been done.
  
  
  METHODS
  Four groups of subspecialists completed time-proctored tests of 20 maxillofacial trauma scans with zygomatic arch, zygomatic complex, orbital, Le Fort I, II, III, mandibular and panfacial fractures from five institutions (n = 40). Accuracy of diagnosis and indication for surgery, efficiency, and preference were assessed. Comparison between two- and three-dimensional scans, between expert (experienced attending) versus novice (resident/fellow), and among the four subspecialties was performed.
  
  
  RESULTS
  For two- and three-dimensional scans, two-dimensional was more accurate for orbital floor/medial wall (40 percent and 34 percent) and frontal sinus (26 percent for diagnostic) fractures. Two-dimensional examinations took 2.3 times longer but were preferred (85 percent). Experts and novices had similar accuracy with three-dimensional scanning, but experts were more accurate with the two-dimensional scanning. Experts were 3.3 times faster with two-dimensional scanning but not with three-dimensional scanning. Accuracy of diagnosis among subspecialists was similar, except that oral surgery was less accurate with orbitozygomatic fractures (79 percent versus 90 to 92 percent); neuroradiology was less accurate with indications for surgery (65 percent versus 87 to 93 percent).
  
  
  CONCLUSIONS
  Differences in diagnostic accuracy exist between two- and three-dimensional maxillofacial scans and between expert and novice readers but not between subspecialties. Combined modalities are preferred.
authors: Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors: Reza
authors: R
authors: Jarrahy
authors: Victoria
authors: V
authors: Vo
authors: Haig A
authors: HA
authors: Goenjian
authors: Christina J
authors: CJ
authors: Tabit
authors: Hurig V
authors: HV
authors: Katchikian
authors: Anand
authors: A
authors: Kumar
authors: Clifton
authors: C
authors: Meals
authors: James P
authors: JP
authors: Bradley
references: Salvolini U. Traumatic injuries: Imaging of facial injuries. Eur Radiol. 2002;12:1253–1261.
references: Laine FJ, Conway WF, Laskin DM. Radiology of maxillofacial trauma. Curr Probl Diagn Radiol. 1993;22:145–188.
references: Scarfe WC. Imaging of maxillofacial trauma: Evolutions and emerging revolutions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2 Suppl):S75–S96.
references: Singh S, Gulati A, Harrison BD, Curtin JJ, Seaton D. Picture archiving and communications system (PACS): The benefits and the problems of digital imaging in the NHS. Clin Med. 2007;7:202–203.
references: Cooper PW, Kassel EE, Gruss JS. High-resolution CT scanning of facial trauma. AJNR Am J Neuroradiol. 1983;4:495–498.
references: Reuben AD, Watt-Smith SR, Dobson D, Golding SJ. A comparative study of evaluation of radiographs, CT and 3D reformatted CT in facial trauma: What is the role of 3D? Br J Radiol. 2005;78:198–201.
references: Saigal K, Winokur RS, Finden S, Taub D, Pribitkin E. Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Facial Plast Surg. 2005;21:214–220.
references: Dos Santos DT, Costa e Silva AP, Vannier MW, Cavalcanti MG. Validity of multislice computerized tomography for diagnosis of maxillofacial fractures using an independent workstation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:715–720.
references: Lopes PM, Moreira CR, Perrella A, Antunes JL, Cavalcanti MG. 3-D volume rendering maxillofacial analysis of angular measurements by multislice CT. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:224–230.
references: Rosset A, Spadola L, Ratib O. OsiriX: An open-source software for navigating in multidimensional DICOM images. J Digit Imaging 2004;17:205–216.
references: Manson PN, Markowitz B, Mirvis S, Dunham M, Yaremchuk M. Toward CT-based facial fracture treatment (Letter). Plast Reconstr Surg. 1990;86:806.
references: Hopper RA, Salemy S, Sze RW. Diagnosis of midface fractures with CT: What the surgeon needs to know. Radiographics 2006;26:783–793.
references: Bagheri SC, Dimassi M, Shahriari A, Khan HA, Jo C, Steed MB. Facial trauma coverage among level-1 trauma centers of the United States. J Oral Maxillofac Surg. 2008;66:963–967.
references: Fox LA, Vannier MW, West OC, Wilson AJ, Baran GA, Pilgram TK. Diagnostic performance of CT, MPR and 3DCT imaging in maxillofacial trauma. Comput Med Imaging Graph. 1995;19:385–395.
references: Gillespie JE, Isherwood I, Barker GR, Quayle AA. Three-dimensional reformations of computed tomography in the assessment of facial trauma. Clin Radiol. 1987;38:523–526.
references: Adler ME, Deahl ST, Matteson SR. Clinical usefulness of two-dimensional reformatted and three-dimensionally rendered computerized tomographic images. J Oral Maxillofac Surg. 1995;53:375–386.
references: Rifenburg RP, Ambroz KG, Chan SB. Resident interpretation of plain radiographs: A comparison of emergency medicine residents by year of training. Am J Emerg Med. 2008;26:366–367.
references: Sherick DG, Buchman SR, Patel PP. Pediatric facial fractures: Analysis of differences in subspecialty care. Plast Reconstr Surg. 1998;102:28–31.
references: Chuong R, Mulliken JB, Kaban LB, Strome M. Fragmented care of facial fractures. J Trauma 1987;27:477–482.