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
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.
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.
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).
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.
[Show abstract][Hide abstract] ABSTRACT: Treatment of facial trauma, damage to the dentition and anatomic structures subsequent to maxillofacial injury is an issue of paramount importance in traumatology. Because in this field, unlike other parts of the body, not only does the surgeon have to deal with the management of the facial fractures, but must also restore the facial functions and features such as visual function (i.e. diplopia), olfaction, breathing (i.e. airway management), mastication (i.e. restora-tion of teeth and occlusion), deglutition and articulation (in addition to the facial appearance of the patient and sym-metry). In no other part of the body is the management of trauma so complex. In patients with multiple fractures of the upper, lower and midface are generally referred to as panfacial fractures treatment is extremely complicated. Often, such fractures are associated with neurological deficits, and require ICU care for other multiple traumas. The quality of life, ability return to work and management of PTSD are other fundamental issues inherent to trauma care, rehabilita-tion and counseling which are of tantamount importance and must not be neglected (1). Nonetheless, the following listed points are worthy of mentioning when faced with these patients and may be of interest for your readership: 1. Complete and exact assessment of not only facial injuries but also, concomitant bodily injuries which may not be evident is necessary. Admission of patients from the emergency ward to maxillofacial ward must be done only after consultations are complete and the patient has been cleared from the other wards (i.e. neurosurgery, surgery, internal medicine etc) (2). 2. Closure of open wounds of the face and oral mucosa and avulsed teeth in patients whose surgery is to be delayed (temporary treatment). 3. Attention to and provision of oral hygiene, and nutrition especially in ICU patients (i.e. in a coma). 4. Preoperative photographs, radiographs and CT scans are mandatory (1). 5. Consultation, coordination and cooperation with other relevant departments (such as neurosurgery, ophthalmol-ogy, otolaryngology, anesthesiology etc.) is prudent (3). 6. Use of submental or Altemeier intubation procedure to obviate the need for tracheotomy and preventing changing of the intubation tube from nasal to oral (1) (Figure 2).
[Show abstract][Hide abstract] ABSTRACT: Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4-87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 01/2013; 41(7). DOI:10.1016/j.jcms.2012.12.004 · 2.93 Impact Factor
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