Validity of computed tomography in diagnosing midfacial fractures

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de Carvalho, MF
Vieira, JNM
Figueiredo, R
Reher, P
Chrcanovic, BR
das Graças Afonso Miranda Chaves, M
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The aim of this study was to evaluate the sensitivity, accuracy, and reliability of two-dimensional computed tomography (2D-CT) scans (axial, coronal, sagittal planes) and three-dimensional computed tomography (3D-CT) reconstructions in diagnosing midfacial fractures in relation to actual fractures identified clinically and during surgery (gold standard). The imaging diagnosis was performed by a radiologist and an oral and maxillofacial surgeon. Sixty-two patients with a total of 429 midfacial fractures were included. Frontal sinus and nose fractures were easily diagnosed. For the three CT planes, there was a statistically significant difference between the CT examination and the gold standard for five to seven of the nine bones evaluated, while for 3D-CT, a difference was observed only for fractures of the orbital floor. The inter-observer agreement between the oral and maxillofacial surgeon and the radiologist was 75.5%. In conclusion, in this study 3D-CT reconstructions showed significantly the best sensitivity, accuracy, and reliability for the diagnosis of midfacial fractures. The sagittal reconstructions were the least diagnostic of the 2D-CT images. For areas where the parameters studied showed less agreement and hence a more difficult diagnosis, we recommend a combination of 3D and 2D-CT images to improve diagnostic accuracy.

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International Journal of Oral and Maxillofacial Surgery

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© 2020 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.

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Computed tomography


Facial trauma

Midfacial fractures

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de Carvalho, MF; Vieira, JNM; Figueiredo, R; Reher, P; Chrcanovic, BR; das Graças Afonso Miranda Chaves, M, Validity of computed tomography in diagnosing midfacial fractures, International Journal of Oral and Maxillofacial Surgery, 2020