Radiology for Maxillofacial Trauma

Maxillofacial Trauma

Radiographs are required to:

Confirm presence of a fracture Assess degree of displacement of fractures Identify other fractures

Nicholas Drage University Dental Hospital, Cardiff

Ymddiriedolaeth GIG Caerdydd ar Fro Cardiff and Vale NHS Trust

Signs of fractures
Direct signs Indirect signs

Direct signs
Separation sign (radiolucent line)
Look for approximation (joining) of fracture lines in the mandible NB If radiolucent line passes beyond bone margin then that particular bone is not fractured

Widening of the periodontal ligament space Widening of sutures

fronto-zygomatic suture, fronto-nasal suture, naso-maxillary suture and in children the internasal suture

Direct signs
Overlap sign (radiopaque line)
Due to overlapping of fragments. Margins may be sharp or diffuse

Direct signswhen broken peice of

Disappearing fragment sign
bones rotates and becomes burnt out on the image.
When thin bone plates are rotated out of the tangent

Abnormal linear density

Fragment displaced/rotated so it is seen in an end on position

Abnormal curvature Step deformity look in lower border of the mandible

Bone Occlusal plane

Displaced Bone

Fracture of the arch - bones gets push in and increases the density at that site.

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Radiology for Maxillofacial Trauma

Indirect signs
Soft tissue swelling the cheek bone punched in the Paranasal sinus opacification
face - bleeding in the maxillary antrum
increase in radioopacity in areas by

Common fracture sites -mandible

Air in the soft tissues

NB fluid levels in sphenoid sinus on a supine lateral view likely to indicate skull base fracture

Changes in the occlusal plane

Le Fort I or dento alveolar fracture Condylar neck fracture

Soft tissue (must exclude laryngeal, tracheal and oesophageal laceration). Orbital Due to orbital floor or medial orbital floor fracture Intracranial

sympaseal fracture

Dental Injury! check bone underneath for

fracure too

parapsyseal fracture
easier to diagnose as there is less overlaping.

pt blows their nose - air comes up through the orbit - sign of a fracture.

VIEWS - PA mandible. x-ray beam parallel to the oor

Anterior view not visible on panaromic/ PA - use 45 degree view, occlusal view

fracture line

Lower 90 dgree angle. Film position the same - on the occlusal plane of the teeth.

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Radiology for Maxillofacial Trauma

no fracture

angle of the mandible - two lines - single fracture as it joins at the lower border of the mandible. two lines are the lingual anf buccal sde of the fracture.

step fracture at the lower border of the manbile. Muscle pull will tend to keep the two fragments together. In an infavourable case - muscle pull the fracture away from each other.

PA mandible. Medial ptergoid will tend to pull the muscles together (a (b) unfavaroable - the muscles will pull the bone apart

air in soft tissue indirect sign of fracture

easier to spot in another view.

step - on the body of the manbible. Widening of the periodontal ligament space.

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Radiology for Maxillofacial Trauma

displacement in the horrozontal plane.

same fracture but as seen in the vertical place. Geniohyoid pull is going to pull the bone down and increase the displacement.

Drop back down due to the effect of the muscles eg. geniohyoid, mylohyoid etc

condylar head pull mesially

lines coming down - faint

fracture of the condyke - lateral ptergoid muscle will tend to pull the condyl forward and mesially

right angle of the mandible - step seen. Symphasis fracture - change in the occlusal plane.

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Radiology for Maxillofacial Trauma

views to diagnose the fractures mentioned in previous slide

Fractures of the middle third of the skeleton

Dento alveolar Zygomatic complex Le Fort I, II, III Naso-ethmoidal complex Fractures of the orbit

Radiographic Views
0 Occipitomental radiograph main ones. 30 Occipitomental radiograph Submentovertex View taken sometimes primarily used for fractures of the zygomatic (Lateral skull) arch
these rst 2 are the

What do you look for?

Symmetry Sharpness
Accentuated sharpness if fragments are rotated into tangent with the x-ray beam (bright sign railroad track or trap door sign Loss of normal sharp outline if fragment rotated out of tangent

Search Patterns
Campbells lines (McGrigors Lines) Trapnells line (used to assess mandible) Dolans lines
Orbital line Zygomatic Line Maxillary line
main one

Sinus Soft Tissue

cambell lines 1) through the ZF suture supraorbital rim, frontal sinus 2) 3) condule, coronoid process, lateral margin of the sinus, nose 4) angle of mandible, occlucal plane Secondary lines will prevent you from missing anything out.

by going through the lines - you can spot the fracture lines.

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Radiology for Maxillofacial Trauma

abnormal linear density visible

90 degreee

submento vertex view. Radiographic basline perpenicular to the oor.

pt has signs of an orbital oor fracture.

30 degree OP view of the same pt. Compare sides to see soft tissue swelling opacication of the sinus seen too.

CT scan - fracure in the orbital oor visible. Msucles trapped in the orbial oor

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Radiology for Maxillofacial Trauma

muscle tethering seen of the same pt.

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