Radiographic diagnosis of mandibular fractures: Mode and implications

Proper treatment of fractures of the mandible is dependent on proper diagnosis of the lesion. Panoramic radiography has become the standard of care for the evaluation of mandibular fractures in many institutions. The ability to obtain these views while the patient is in the supine position is a great asset in trauma centers where the patient may be unstable, and in patients for whom the cervical spine (C-spine) has not been cleared. Proper radiologic evaluation of the C-spine may be the most important part of the radiologic workup in the evaluation of mandibular trauma since it influences the options for evaluation of the mandible. Panoramic views with posteroanterior or reverse Towne's views are likely to give a higher yield than the panoramic view alone. The periapical view can be useful to identify specific dental trauma or abscesses. Occlusal views are under utilized, and can be very useful when used intraoperatively on patients with symphyseal and parasymphyseal fractures to avoid splaying of the lingual cortex, and widening of the mandibular width. The use of computed tomography (CT) as a diagnostic tool has been controversial in the past. Early studies comparing the sensitivity of CT to other modalities of the radiographic workup suggested that CT was not as sensitive. More recent studies performed with improved, higher resolution CT suggest that CT is superior to panoramic radiography, both in sensitivity and in offering the surgeon a better understanding of the nature of the fractures. Three-dimensional CT may have an important role in the future for evaluating pre- and postreduction techniques, particularly of subcondylar fractures. New multislice CT technology will further improve the resolution and speed of CT imaging and reconstructions.