Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?
BACKGROUND
Because of its functional and cosmetic importance, facial injuries, especially bony fractures are clinically very significant. Missed and maltreated fractures might result in malocclusion and disfigurement of the face, thus making accurate diagnosis of the fracture very essential. In earlier times, conventional radiography along with clinical examination played a major role in diagnosis of maxillofacial fractures. However, it was noted that the overlapping nature of bones and the inability to visualise soft tissue swelling and fracture displacement, especially in face, makes radiography less reliable and useful. Computed tomography (CT), also called as X-ray computed radiography, has helped in solving this problem. This clinical study is to compare three-dimensional (3D) CT reconstruction with conventional radiography in evaluating the maxillofacial fractures preoperatively and effecting the surgical management, accordingly.


METHODS
Fifty patients, with suspected maxillofacial fractures on clinical examination, were subjected to conventional radiography and CT face with 3D reconstruction. The number and site of fractures in zygoma, maxilla, mandible and nose, detected by both the methods, were enumerated and compared. The final bearing of these additional fractures, on the management protocol, was analysed.


RESULTS
CT proved superior to conventional radiography in diagnosing additional number of fractures in zygoma, maxilla, mandible (subcondylar) and nasal bone. Coronal and axial images were found to be significantly more diagnostic in fracture sites such as zygomaticomaxillary complex, orbital floor, arch, lateral maxillary wall and anterior maxillary wall.


CONCLUSIONS
3D images gave an inside out picture of the actual sites of fractures. It acted as mind's eye for pre-operative planning and intra-operative execution of surgery. Better surgical treatment could be given to 33% of the cases because of better diagnostic ability of CT.
Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Sheerin
S
Shah
Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Sanjeev K
SK
Uppal
Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Rajinder K
RK
Mittal
Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Ramneesh
R
Garg
Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Kavita
K
Saggar
Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Rishi
R
Dhawan
Computed tomography scan in maxillofacial fracture; diagnostic tools in facial fractures; radiography in maxillofacial fractures; three-dimensional computed tomography in facial fractures