Computed tomography and thin-section tomography in facial trauma

The efficacy of radiographic methods in detecting and classifying facial fractures was assessed. Thirty-one patients with maxillofacial trauma were studied with plain radiography, coronal and lateral pluridirectional tomography (PT), and axial and direct coronal computed tomography (CT). PT and CT were compared to assess how many fractures each method could demonstrate. In addition, plain films were used in combination with each special study to see how efficacious each combination was at classifying fractures into types, such as blow-out, tripod, etc. To reflect the fact that it is sometimes impossible to obtain lateral PT or direct coronal CT scans at this institution, the same analysis was done using just coronal PT and axial CT. With two projections, CT was better than PT at demonstrating fractured surfaces (168 vs. 156) and in classifying fractures in combination with plain films (48 vs. 43). However, when only one projection from each special study was used, PT surpassed CT in showing fractures (137 vs. 124) and in classifying fractures (42 vs. 40). Failures with each method occurred when the plane of section was parallel or oblique to the plane of the structure being examined, that is, axial CT failed to show the floor of the orbit well and coronal PT failed to show the anterior maxillary sinus wall well. Imaging in two planes, including the coronal plane, is desirable for greatest accuracy in fracture detection, whether by CT, PT, or both. CT is generally better for the display of soft-tissue abnormalities.
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