Journal articles on the topic 'Maxillofacial fractures detection'

Purpose The aim of the study was to explore the application value of computerized tomography (CT) scan 3D reconstruction technology in maxillofacial fracture patients. Methods A total of 80 maxillofacial fracture patients who underwent surgical treatment in Shijiazhuang People's Hospital from January 2019 to January 2020 were enrolled. All of them received 128-slice spiral CT scans before surgery, and the images were subjected to multiplanar reconstruction (MRP) and volume reconstruction (VR). Results A total of 181 fractures were found in 80 patients with maxillofacial fractures. The detection rates of axial CT, MRP, and VR were 77.90% (141/181), 93.92% (170/181), and 97.79% (177/181), respectively. The detection rates of the four inspection methods were statistically different. Taking the findings of surgical anatomy as the gold standard, the sensitivity of MRP and VR for the diagnosis of maxillofacial fractures was 90.06% (163/170) and 95.56% (174/177), with no significant difference. Conclusion CT scan 3D reconstruction technology has a high application value in the clinical diagnosis and treatment of maxillofacial fracture patients.

An original maxillofacial fracture detection system (MFDS), based on convolutional neural networks and transfer learning, is proposed to detect traumatic fractures in patients. A convolutional neural network pre-trained on non-medical images was re-trained and fine-tuned using computed tomography (CT) scans to produce a model for the classification of future CTs as either “fracture” or “noFracture”. The model was trained on a total of 148 CTs (120 patients labeled with “fracture” and 28 patients labeled with “noFracture”). The validation dataset, used for statistical analysis, was characterized by 30 patients (5 with “noFracture” and 25 with “fracture”). An additional 30 CT scans, comprising 25 “fracture” and 5 “noFracture” images, were used as the test dataset for final testing. Tests were carried out both by considering the single slices and by grouping the slices for patients. A patient was categorized as fractured if two consecutive slices were classified with a fracture probability higher than 0.99. The patients’ results show that the model accuracy in classifying the maxillofacial fractures is 80%. Even if the MFDS model cannot replace the radiologist’s work, it can provide valuable assistive support, reducing the risk of human error, preventing patient harm by minimizing diagnostic delays, and reducing the incongruous burden of hospitalization.

Introduction: Maxillofacial injuries are one of the most frequently encountered entities accounting for a large proportion of patients in emergency department. Present study was performed to assess the role of multidetector computed tomography (MDCT) in patients of maxillofacial trauma and to describe the spectrum of various patterns of injuries in maxillofacial region in this part of Nepal. Methods: The study was carried out on a prospective basis over a period of one year. All the patients referred for evaluation of maxillofacial trauma were included in the study. MDCT was done in patients of maxillofacial injury and the data was recorded and analyzed. Volumetric MDCT scan of the maxillofacial region was performed in axial plane with multiplanar reconstruction in coronal and sagittal planes were obtained wherever required. Results: Out of 60 patients of maxillofacial trauma 42 (70%) were males and 18 (30%) were females and age ranges from 12 to 70 years. The 11?30 years age group has the highest percentage (55%) of maxillofacial trauma, followed by 31?40 (20%). The common cause of injuries in our study was road traffic accidents (58.33%), fall from height (20%), physical assault (16.66%) and sport injuries (5%). Out of 60 patients there was total of 115 fractures. The frequency and types of fracture was as follows: orbital floor fracture in 21 (35%), maxillary sinus wall fracture in 18 (30%), nasal bone fracture in 17 (28.33%), jaw fracture in 15 (25%), zygomatic bone fracture in 13 (21.66%), orbital wall fracture in 11 (18.33%), naso?ethmoidal fractures in 9 (15%), frontal sinus fracture in 7 (11.66%), Lefort fracture in 1 (1.66%) and others 3 (5%). The highest percentage of fracture was of orbital floor (35%) followed by fracture of wall of maxillary sinus (30%) and nasal bone fracture (28.33%). Three cases had simultaneous injury of the globe and cervical spine; they underwent computed tomography/magnetic resonance imaging for the assessment of spine. Conclusion: Injuries to maxillofacial region is one of the most common emergency requiring accurate and early diagnosis for preventing unnecessary investigations and proper management. MDCT has high sensitivity and specificity and has high accuracy for detection of fracture. DOI: http://dx.doi.org/10.3126/ajms.v5i4.9561 Asian Journal of Medical Sciences 2014 Vol.5(4); 39-43

Introduction: Zygomaticomaxillary complex fractures are second most common facial injuries. These fracture are managed either by open reduction with rigid fixation or conservatively. Objective: To compare infra orbital nerve outcome in zygomaticomaxillary complex fractures treated surgically and conservatively. Methodology: The current randomized controlled trial study was carried out at Oral and Maxillofacial Surgery Department, Sandeman Provincial Hospital/Bolan Medical College Quetta from 23/04/2018 to 22/10/2018 after the synopsis approval. Total sample size calculated was 100. 50 patients in Group-A were treated by open reduction and internal fixation technique and 50 patients in Group-B were managed conservatively without any intervention. All the data was recorded in a specialized proforma for this study. Data analysis was done by SPSS. Results: The overall mean age (SD) of the patient’s was 36.2±7.1 years. Most of the patients (n=64, 64.0%) were 31-45 years old. The male patients in our study were 65 (65.0%) whereas female participants were 35 (35.0%). For detection of mechanical threshold, the patients proportion with sensations at 3cm filament length was significantly lower in patients who underwent surgical treatment (78.0% vs. 100.0%; p-value<0.001) as compared to the participants managed conservatively. It was also lower significantly at 5cm and 7cm for Group-A in comparison to Group-B (p-value≤0.05). For detection of heat threshold, the patients proportion with sensation at 32°C was no different between Group-A and Group-B (p-value=0.529). However, proportion of patients with sensations at 35oC (64.0% vs. 100.0%; p-value<0.001) and 37oc (90.0% vs. 100.0%; p-value=0.022) was lower significantly in surgically treated patients. Pain threshold detection was significantly lower in patients who underwent surgical treatment (1.26±0.44 vs. 1.58±0.49; p-value<0.001) in comparison to conservative treatment. Conclusion: In patients with zygomaticomaxillary complex fractures, infra orbital nerve outcome was superior in patients managed conservatively than those treated with open reduction and internal fixation which advocates evading unnecessary intervention in such cases in future practice. Keywords: Zygomaticomaxillary Complex Fractures, Conservative Treatment, Infra Orbital Nerve

Background: Open reposition and rigid internal fixation are the main methods of treatment for traumatic injuries of the facial skull and an important stage of bone-plastic, reconstructive, and orthognathic surgery. In contemporary maxillofacial surgery, fixators, implants, and endoprostheses made of titanium or its alloys are widely used due to the high corrosion resistance and biocompatibility. However, recent studies have shown that none of the metal implants used in maxillofacial surgery, orthopedics or traumatology is completely inert. Moreover, they always interact with the surrounding biological environment. Thus, a number of studies have revealed the release of titanium to the adjacent soft tissues. Material and Methods: Titanium fixators (plates and screws) removed in 12 patients in late terms after osteosynthesis, as well as biopsies of the periosteum and fibrous capsule adjacent to the fixation elements made of titanium were investigated. Microscopic fluorescence spectroscopic analysis (M4 TORNADO micro-ray fluorescence spectrometer; Bruker, Bremen, Germany) was used to determine the elemental composition of the removed soft tissue fragments. Scanning electron microscopy (microscope model JSM-6060; JEOL, Japan) was used to study structural changes on the surface of titanium plates and screws. The obtained results were analized with the use of Spirman correlation coefficient, calculated by the IBM SPSS Statistics v.23 software. Results: X-ray fluorescence analysis revealed the inclusion of titanium in all investigated samples with an average content of titanium 48.14% ± 31.1% in metal deposition areas. For samples removed in patients with traumatic facial fractures after metallosteosynthesis, the average content of titanium was 55.6%, and for reconstructive surgeries – 37.72%. The acquired maps of the element deposition showed no topographic inhomogenity of titanium particles distribution. The main distribution patterns were the following: 1) areas of clearly outlined intensive titanium inclusions (90.9-800 μm), and 2) diffuse titanium inclusions which were poorly demarcated. Electronic microscopy of the investigated fixators revealed deformation of the thread, bending of screws, deformation and surface defects of the plates caused by mechanical damage, including microcracks, sharp edges, scratches, dimples.

Abstract Accurate and early diagnosis of vertical root fractures (VRFs) is imperative to prevent extensive bone loss and unnecessary endodontic and prosthodontic treatments. The aim of this study was to assess the effect of time lapse on the diagnostic accuracy of cone beam computed tomography (CBCT) for VRFs in endodontically treated dog's teeth. Forty-eight incisors and premolars of three adult male dogs underwent root canal therapy. The teeth were assigned to two groups: VRFs were artificially induced in the first group (n=24) while the teeth in the second group remained intact (n=24). The CBCT scans were obtained by NewTom 3G unit immediately after inducing VRFs and after one, two, three, four, eight, 12 and 16 weeks. Three oral and maxillofacial radiologists blinded to the date of radiographs assessed the presence/absence of VRFs on CBCT scans. The sensitivity, specificity and accuracy values were calculated and data were analyzed using SPSS v.16 software and ANOVA. The total accuracy of detection of VRFs immediately after surgery, one, two, three, four, eight, 12 and 16 weeks was 67.3%, 68.7%, 66.6%, 64.6%, 64.5%, 69.4%, 68.7%, 68% respectively. The effect of time lapse on detection of VRFs was not significant (p>0.05). Overall sensitivity, specificity and accuracy of CBCT for detection of VRFs were 74.3%, 62.2%, 67.2% respectively. Cone beam computed tomography is a valuable tool for detection of VRFs. Time lapse (four months) had no effect on detection of VRFs on CBCT scans.

Evaluation of the traumatized patient frequently involves consideration of possible cervical spine injury. When neurological deficits, unconsciousness, alcoholic intoxication, severe maxillofacial or head trauma, or local neck pain are present, it is an easy decision to obtain cervical spine x-rays. The dilemma arises in the patient without neck pain who has mild to moderate scalp or facial injuries. Such a patient usually arrives in the emergency department with a cervical collar placed by pre-hospital personnel because of the mechanism of injury and the associated head or facial soft tissue trauma. Due to the association of cervical spine fractures with “significant” facial trauma, neck x-rays have been recommended. What, however, constitutes “significant” facial trauma To delineate such facial injuries, a retrospective analysis of 30 patients with cervicalspine fractures hospitalizedin a five year period at the University of Nebraska Medical Center was performed. Seventeen patients had head, scalp or facial injuries ranging from skull fractures and scalp hematomas to minor abrasions and lacerations. To determine if cervical spine films are being over utilized, a current prospective study of patients undergoing this evaluation will be presented, detailing the facial and head injuries, location, degree of severity, and detection of cervical spine injuries.

Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. New approaches for intra-oral radiography allow investigators to conduct densitometric assessments of dento-alveolar structures. Longitudinal changes in alveolar bone can be studied by computer-assisted image analysis programs. These techniques have been applied to dimensional analysis of the alveolar crest, detection of gain or loss of alveolar bone density, peri-implant bone healing, and caries detection. Dental applications of computed tomography (CT) include the detailed radiologic anatomy of alveolar processes, orofacial soft tissues and air spaces, and developmental defects. Image analysis software permits bone mass mineralization to be quantified by means of CT data. CT has also been used to study salivary gland disease, injuries of the facial skeleton, and dental implant treatment planning. Magnetic resonance imaging (MRI) has been used extensively in retrospective and prospective studies of internal derangements of the temporomandibular joint. Assessments based on MRI imaging of the salivary glands, paranasal sinuses, and cerebrovascular disease have also been reported. Magnetic resonance spectroscopy (MRS) has been applied to the study of skeletal muscle, tumors, and to monitor the healing of grafts. Nuclear imaging provides a sensitive technique for early detection of physiological changes in soft tissue and bone. It has been used in studies of periodontitis, osteomyelitis, oral and maxillofacial tumors, stress fractures, bone healing, temporomandibular joint, and blood flow. This article includes brief descriptions of the technical principles of each imaging modality, reviews their previous uses in oral biology research, and discusses potential future applications in research protocols.

Objectives: Cone-Beam Computed Tomography is an alternative imaging technique which has been recently introduced in the field of Oral &amp; Maxillofacial Radiology. It has rapidly gained great popularity among clinicians due to its ability to detect lesions and defects of the orofacial region and provide three-dimensional information about them. In the field of Endodontics, CBCT can be a useful tool to reveal tooth morphology irregularities, additional root canals and vertical root fractures. The objective of this study is to evaluate the root and root canal morphology of the maxillary permanent molars in Greek population using Cone-Beam Computed Tomography.Materials and Methods:273 cone-beam computed tomography (CBCT) images were examined. The number of roots and root canals of the first and second maxillary molars were evaluated. Root canal configuration was classified according to Weine’s classification by two independent examiners and statistical analysis was performed.Results:A total of 812 molars (410 first and 402 second ones) were evaluated. The vast majority of both first and second molars had three roots (89.26% and 85.07%, respectively). Most first molars had four canals, while most second molars had three. In the mesiobuccal roots, one foramen was recorded in 80.91% of all teeth. Other rare morphologic variations were also found, such as fusion of a maxillary second molar with a supernumerary tooth.Conclusion:Within the limitations of this study, it can be concluded that more attention should be given to the detection of additional canals during root canal treatment in maxillary permanent molars. Towards this effort, CBCT can provide the clinician with supplemental information about the different root canal configurations for successful Root Canal Treatment.

Background: Nasal bone fractures are the most typical kind of facial injuries. In recent years, ultrasonography has been suggested as an alternative method for detecting maxillofacial fractures. It can eliminate the risk of radiation exposure, especially in children and pregnant women. The objective of present study was to compare the diagnostic competency of conventional radiography with ultrasonography in the diagnosis of nasal injuries specially, fractures. Method: In prospective research, 331 patients with a history of midfacial trauma were enrolled. Following clinical examination, radiographs were obtained in lateral and occipitomental views. Ultrasonography was performed by an experienced sonologist, blinded to clinical findings in right and left lateral sides in addition to nasal dorsum. Images were analyzed by an experienced radiologist. Sensitivity, specificity and predictive values of radiology and US were determined by comparing their results with findings of the clinical examination as the gold standard. Results: In assessment of nasal fractures the sensitivity and specificity of ultrasonography were 97.79% and 97.66%, respectively; while for radiography these two factors were 81.21% and 86.66%, respectively. Based on the Chi-square test, ultrasonography was notably greater to radiography in diagnosing nasal fractures (P<0.001). Conclusion: Compared with radiography, ultrasonography had a higher sensitivity and specifity in detecting nasal fractures and seems to be an adequate method for the diagnosis of nasal fractures.

Aim: Verify the accuracy of objective assessments compared to subjective tests in detecting changes in somatosensory perception in individuals affected by maxillofacial trauma. Methods: The review (PROSPERO n ° CRD42019125546) used the databases: MEDLINE, Cochrane, EMBASE, LILACS and other bibliographic resources. Prospective and retrospective studies that used objective and subjective methods of assessing facial sensitivity in maxillofacial fractures were included. There was no restriction on language or publication date. Risk of bias was assessed using the QUADAS-2. Data extraction and analysis were performed using a form developed for the study. Results: 21 studies were included. The clinical objective examination mainly includes assessments of: tactile sensitivity (95.24%) and nociceptive sensitivity (57.14%). The subjective assessment was based on the patient’s report, spontaneously (61.90%), guided by structured questionnaires (33.33%) and/or using scales (9.52%) to measure the degree of impairment. In risk of bias assessment, were observed no adequate interpretation and classification of changes in subjective sensitivity, subject to inappropriate analysis of the data. In addition, the studies bring several instruments without standardization for assessing sensory modalities. Conclusion: The objective assessment is a complement to the subjective assessment, using the touch assessment as the main parameter in the profile of the facial peripheral integrity, associated or not with nociceptive assessment. Lack of consensus on the indication of specific instruments for testing is a limiting factor. Thus, based on the studies, is proposed a minimum battery of sensitivity assessment to obtain an overview of the patient’s peripheral nervous situation.

Phosphaturic mesenchymal tumor (PMT) is strongly related to tumor-induced osteomalacia (TIO) which brings diverse skeletal events, such as bony deformities, gait disturbance, and multiple bone fractures. Overexpressed fibroblast growth factor 23 by the tumor induces hypophosphatemia leading to the oncogenic osteomalacia, a rare paraneoplastic syndrome. PMT occurring in the oral and maxillofacial regions is extremely rare, and this case highlights the need to understand mechanisms by which local lesions can affect systemic conditions, and the importance of a combination of physical examinations, laboratory investigations, and radiologic investigations for a decisive diagnosis.

Objectives: The evidence for diagnostic accuracy using cone beam computed tomography (CBCT) for dental applications depends heavily on ex vivo research, but there is little knowledge of whether the model used affects the diagnostic accuracy results. The objective of this study was to determine the impact of different designs of anthropomorphic models on diagnostic accuracy for the specific task of dental root fracture detection. Methods: Horizontal or oblique root fracture was induced in 24 of 48 permanent maxillary incisors. The 48 teeth were scanned by CBCT using standard clinical exposure factors on five occasions, each with a different model design. Scans were viewed by five dental and maxillofacial radiologists, who each made a forced diagnosis of fracture or no fracture in each root and a judgment on root fracture using a five-point confidence scale. Sensitivity (Se), specificity (Sp) and areas under receiver operating characteristic (ROC) curve (Az) were calculated for each observer for each model. Results: There were no significant differences between the diagnostic accuracy measurements recorded using different models. There were, however, numerous significant differences between observers using the same anthropomorphic model. Conclusions: Despite the differences in X-ray attenuation between the five model designs, the results suggest that the anthropomorphic model does not affect the results of diagnostic accuracy studies on root fracture using this CBCT machine at standard clinical exposures. This provides some confidence in the previously published evidence. The interobserver diagnosis differences indicate that research using only two observers could provide misleading results.

AbstractThe purpose of this study was to evaluate the performance of convolutional neural network-based models for the detection and classification of maxillofacial fractures in computed tomography (CT) maxillofacial bone window images. A total of 3407 CT images, 2407 of which contained maxillofacial fractures, were retrospectively obtained from the regional trauma center from 2016 to 2020. Multiclass image classification models were created by using DenseNet-169 and ResNet-152. Multiclass object detection models were created by using faster R-CNN and YOLOv5. DenseNet-169 and ResNet-152 were trained to classify maxillofacial fractures into frontal, midface, mandibular and no fracture classes. Faster R-CNN and YOLOv5 were trained to automate the placement of bounding boxes to specifically detect fracture lines in each fracture class. The performance of each model was evaluated on an independent test dataset. The overall accuracy of the best multiclass classification model, DenseNet-169, was 0.70. The mean average precision of the best multiclass detection model, faster R-CNN, was 0.78. In conclusion, DenseNet-169 and faster R-CNN have potential for the detection and classification of maxillofacial fractures in CT images.

Early detection and treatment of face bone fractures reduce long-term problems. Fracture identification needs CT scan interpretation, but there aren't enough experts. To address these issues, researchers are classifying and identifying objects. Categorization-based studies can't pinpoint fractures. Proposed Study Convolutional neural networks with transfer learning may detect maxillofacial fractures. CT scans were utilized to retrain and fine-tune a convolutional neural network trained on non-medical images to categorize incoming CTs as "Positive" or "Negative." Model training employed maxillofacial fractogram data. If two successive slices had a 95% fracture risk, the patient had a fracture. In terms of sensitivity/person for facial fractures, the recommended strategy beat the machine learning model. The recommended approach may minimize physicians' effort identifying facial bone fractures in face CT. Even though technology can't fully replace a radiologist, the recommended technique may be helpful. It reduces human error, diagnostic delays, and hospitalization costs.

The fracture of the bone is common issue in human body occurs when the pressure is applied on bone or minor accident and also due to osteoporosis and bone cancer. Therefore the accurate diagnosis of bone fracture is an important aspects in medical field. In this work X-ray/CT images are used for the bone fracture analysis. The main aim of the this project is to develop an image processing based efficient system for a quick and accurate classification of bone fractures based on the information gained from the x-ray / CT images of the skull. X- ray/CT scan images of the fractured bone are collected from the hospital and processing techniques like pre-processing method, segmentation method, edge detection and feature extraction methods are adopted. The images are tested out by considering the image slice of single slice and also grouping the slices of the patients. The patients CT scan/X-ray image was classified if bone is fractured then if two following slices were categorized with a probability fracture higher than 0.99. The results of the patient x-ray images show that the model accuracy of the maxillofacial fractures is contains 80%. Even the radiologist’s work is not replaced by the MFDS model system, it is useful only for the providing valuable assistive support, it reduces the human error in the medical field, preventing the harm for the patients by minimizing the diagnostic delays, and reducing the incongruous burden of hospitalization.

AbstractMandibular fractures are among the most frequent facial traumas in oral and maxillofacial surgery, accounting for 57% of cases. An accurate diagnosis and appropriate treatment plan are vital in achieving optimal re-establishment of occlusion, function and facial aesthetics. This study aims to detect mandibular fractures on panoramic radiographs (PR) automatically. 1624 PR with fractures were manually annotated and labelled as a reference. A deep learning approach based on Faster R-CNN and Swin-Transformer was trained and validated on 1640 PR with and without fractures. Subsequently, the trained algorithm was applied to a test set consisting of 149 PR with and 171 PR without fractures. The detection accuracy and the area-under-the-curve (AUC) were calculated. The proposed method achieved an F1 score of 0.947 and an AUC of 0.977. Deep learning-based assistance of clinicians may reduce the misdiagnosis and hence the severe complications.

Objectives: This study aims to evaluate the performance of ResNet models in the detection of in vitro and in vivo vertical root fractures (VRF) in Cone-beam Computed Tomography (CBCT) images. Methods: A CBCT image dataset consisting of 28 teeth (14 intact and 14 teeth with VRF, 1641 slices) from 14 patients, and another dataset containing 60 teeth (30 intact and 30 teeth with VRF, 3665 slices) from an in vitro model were used for the establishment of VRFconvolutional neural network (CNN) models. The most popular CNN architecture ResNet with different layers was fine-tuned for the detection of VRF. Sensitivity, specificity, accuracy, PPV (positive predictive value), NPV (negative predictive value), and AUC (the area under the receiver operating characteristic curve) of the VRF slices classified by the CNN in the test set were compared. Two oral and maxillofacial radiologists independently reviewed all the CBCT images of the test set, and intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement for the oral maxillofacial radiologists. Results: The AUC of the models on the patient data were: 0.827(ResNet-18), 0.929(ResNet-50), and 0.882(ResNet-101). The AUC of the models on the mixed data get improved as:0.927(ResNet-18), 0.936(ResNet-50), and 0.893(ResNet-101). The maximum AUC were: 0.929 (0.908–0.950, 95% CI) and 0.936 (0.924–0.948, 95% CI) for the patient data and mixed data from ResNet-50, which is comparable to the AUC (0.937 and 0.950) for patient data and (0.915 and 0.935) for the mixed data obtained from the two oral and maxillofacial radiologists, respectively. Conclusions: Deep-learning models showed high accuracy in the detection of VRF using CBCT images. The data obtained from the in vitro VRF model increases the data scale, which is beneficial to the training of deep-learning models.

Abstract Background Maxillofacial fractures are a common cause of visits to emergency department, accounting for more than 400,000 annual visits in the United States. Gold standard diagnostic tool is conventional computerized tomography (CT) or 3DCT reconstruction. However, the disadvantages of CT are radiation exposure, unavailable in some hospital and expensiveness. Whereas the bony structures overlap is a problem in diagnostic when using plain film X-ray. The objective of this study is to show the accuracy of a linear-probe ultrasound compared to computed tomography and plain film X-ray in diagnosis of infraorbital rim fracture. Methods Patients clinically suspected of an inferior orbital rim fracture underwent linear-probe ultrasonographic investigation, plain film X-ray and CT. CT was used as gold standard in this diagnostic study. A radiologist and senior resident of plastic surgery were the examiner and interobserver for comparison. Result A total of 34 patients with suspected infraorbital rim fractures were investigated. Sensitivity of the linear-probe ultrasonography versus CT in the detection of infraorbital rim fracture was 92.9% (95% CI 66.1–99.8), specificity was 90.0% (95% CI 68.3–98.8), positive predictive value was 86.7% (95% CI 59.5–98.3), negative predictive value was 94.7% ( 95% CI 74.0–99.9), accuracy 91%. Conclusion Linear probe ultrasonography is a good diagnostic tool and has better reliability than the plain film X-ray and can be used as alternative to CT in inferior orbital rim fracture.

Objective: With the collaboration of the trauma department, our study was designed to compare the effectiveness of ultrasonography (USG) and conventional radiography in the detection of bony fractures related to oral and maxillofacial regions. Methodology: This comparative study was conducted from March 2020 to March 2021 by the Radiology department of Sarghoda medical college hospital with the collaboration of the trauma department. Ultrasonography was performed by using GE- USG machine along with a linear extraoral transducer (frequency range 7-15 MHZ). Patients were asked to sit in a seated position facing the sinologist. Transducers were placed over the site by applying the sterile gel. Results: The overall sensitivity and specificity rate of ultrasonography was reported as 83.33% and 98.88% respectively in all sites whereas the sensitivity and specificity rate of conventional radiographs were reported as 70.24%, 100%. The negative predictive value of USG was reported as 96.17% along with 94.59% positive predictive value. In the contrast, conventional radiography gave a better positive predictive value (100%) than USG In our study we found better results of ultrasonography in terms of sensitivity and negative predictive value. Conclusion: In conclusion, our study depicts that ultrasonography is an economical, useful diagnostic tool for examining the bony fractures of facial trauma with a better sensitivity rate when compared to conventional radiographs.

Objectives: As-low-as-diagnostically-acceptable (ALADA) doses are substantially lower than current diagnostic reference levels. To improve dose management, a reference quality approach was tested in which phantom quality metrics of a clinical ALADA dose reference protocol were used to benchmark potential ALADA dose protocols for various scanner models. Methods: Spatial resolution, contrast resolution, contrast-to-noise ratio (CNR) and subjective noise and sharpness were evaluated for a clinical ALADA dose reference protocol at 80 kV and 40 mA (CTDIvol 2.66 mGy) and compared with test protocols of two CT scanners at 100 kV and 35 mA (3.08–3.44 mGy), 80 kV and 54–61 mA (2.65 mGy), 80 kV and 40 mA (1.73–1.92 mGy), and 80 kV and 21–23 mA (1.00–1.03 mGy) using different kernels, filtered backprojection and iterative reconstructions. The test protocols with the lowest dose showing quality metrics non-inferior to the reference protocol were verified in a cadaver study by determining the diagnostic accuracy of detection of maxillofacial fractures and CNR of the optical nerve and rectus inferior muscle. Results: 36 different image series were analysed in the phantom study. Based on the phantom quality metrics, potential ALADA dose protocols at 1.73–1.92 mGy were selected. Compared with the reference images, the selected protocols showed non-inferiority in the detection and classification of maxillofacial fractures and non-inferior CNR of orbital soft tissues in the cadaver study. Conclusions: Reference quality metrics from clinical ALADA dose protocols may be used to guide selection of potential ALADA dose protocols of different CT scanners.

Abstract Background Several Arab countries as well as many parts of the world are currently involved in armed conflicts. Characterization and documentation of combat-related injury patterns and their impact on healthcare are a difficult challenge. However, it is crucial in planning and developing of strategies capable of addressing the demands of ill-equipped medical facilities. The aim of this study was to record the different patterns of combat-related injuries sustained by civilians transferred to Egyptian tertiary hospitals for further investigation and definite treatment after primary stabilization by an emergency trauma team in their countries. Results Metallic foreign bodies were detected in different body locations in 49.1% of patients, while bullets were identified in 12.3%. Injuries involving the musculoskeletal system of the extremities were the most frequent (77.2%), followed in descending order by maxillofacial injuries (41%), thoracic injuries (32.1%), cranial injuries (31%), abdominal injuries (21.1%), spinal injuries (8.8%), and vascular injuries (4.7%). Among the extremities injuries, bone fractures were the most common (68.5%). Conclusion Radiological assessment aids in the evaluation of patients coming from conflict zones pre- and postoperatively, to recognize the precise sites and types of their injuries, the number and location of metallic shrapnel or bullets, and detection of possible associated complications, which aid in accurate demonstration of the extent and patterns of combat-related injuries and guide the management plan.

TÓM TẮT Đặt vấn đề: Gãy phức hợp xương hàm trên xương gò má - cung tiếp ngày càng gia tăng chủ yếu do tai nạn giao thông. Phim cắt lớp vi tính chùm tia hình nón đánh dấu bước tiến lớn trong chẩn đoán hình ảnh hàm mặt. Phương pháp phẫu thuật kết hợp xương bằng nẹp vít nhỏ đã được sử dụng rộng rãi trên thế giới và cho thấy có nhiều ưu điểm nhờ vào sự cải tiến không ngừng về chất liệu, hình dạng, kích thước. Phương pháp: Gồm 46 bệnh nhân bị chấn thương hàm mặt có chụp phim cắt lớp vi tính chùm tia hình nón, được chẩn đoán gãy phức hợp xương hàm trên, gò má cung tiếp và phẫu thuật kết hợp xương bằng nẹp vít nhỏ tại Trung tâm Răng Hàm Mặt Bệnh viện Trung Ương Huế trong thời gian từ tháng 03/2020 đến 03/2021. Nghiên cứu mô tả tiến cứu có can thiệp lâm sàng, không đối chứng. Đánh giá kết quả dựa vào tiêu chí về giải phẫu, chức năng và thẩm mỹ Kết quả: Nhóm tuổi thường gặp là nhóm từ > 18-40 tuổi chiếm 69,6%. Giới: nam 80,4%, nữ 19,6%. Nguyên nhân thường do tai nạn giao thông: 93,5%. Triệu chứng lâm sàng: 100% biến dạng mặt; 80,4% đau chói khi ẩn điểm gãy; 71,7% há miệng hạn chế; 63% có sai khớp cắn. Độ đặc hiệu của hình ảnh lát cắt ngang, lát cắt đứng ngang đều bằng 1 so với phim 3D. Tỷ lệ phát hiện đường gãy (độ nhạy) của hình ảnh lát cắt ngang, lát cắt đứng ngang đều thấp hơn trên phim 3D với tỷ lệ dao động 0,64 đến 1. Kết quả điều trị sau 6 tháng: tốt có 89,1%, khá có 10,9% và không có kém. Kết luận: Gãy phức hợp xương hàm trên, gò má – cung tiếp nguyên nhân chủ yếu do tai nan giao thông. Phim cắt lớp vi tính chùm tia hình nón có giá trị cao với chất lượng hình ảnh tốt để chẩn đoán. Phương pháp kết hợp xương bằng nẹp vít nhỏ cho kết quả tốt về cả 3 phương diện giải phẫu, chức năng và thẩm mỹ ABSTRACT CLINICAL CHARACTERISTICS, CONE BEAM COMPUTED TOMOGRAPHY IMAGES AND TREATMENT RESULTS OF ZYGOMATICOMAXILLARY COMPLEX FRACTURE Introduction: Zygomaticomaxillary complex fracture are increasing due to traffic accidents. Cone-beam computed tomography shows a major advance in maxillofacial imaging. The surgical method using mini-plates has been widely used in the world and has shown many advantages thanks to the continuous improvement in materials, shapes and sizes. Methods: A prospective descriptive study was conducted on 46 patients with facial traumas. The patients underwent conebeam computed tomography, which were diagnosed with complex fractures of zygomaticomaxillary complex fractures. They then underwent fixation techniques using miniplates at Odonto-stomatology Center, Hue Central Hospital, between March 2020 and March 2021. The results based on anatomical, functional and aesthetic criteria were evaluated. Results: Most patients were in the age group of > 18-40 years old, accounting for 69.6%. Gender: Male: 80.4%, female: 19.6%. Causes were usually traffic accidents: 93.5%. Clinical symptoms were: 100% facial deformities; 80.4% throbbing pain when pressing at fractured points; 71.7% trismus; 63% malocclusion; 50% of conjunctival hemorrhage; 47.8% of soft tissue wounds; 45.7% numbness. The specificity of horizontal and coronal cross-section radiograph is equal to 1 - compared to 3D radiograph. The detection rate of fracture (sensitivity) of horizontal cross-section film was lower than 3D radiograph, with a range from 0.64 to 1. Treatment results were excellent in 89.1%, good in 10.9% and none (0%) in bad. Conclusion: Fixation of bone with miniplates and screws is a method that results in excellent outcomes, facilitates patients to heal fast. Miniplates and screws do not have any reactions to humans’ bodies after placing them. Keywords: zygomaticomaxillary complex fractures, conebeam computed tomography, miniplates

Embora as rotas de transmissão da COVID-19 ainda não estejam totalmente identificadas, a transmissão homem-a-homem já é uma realidade em muitos países. Este trabalho tem por objetivo reunir recomendações dos órgãos de saúde e de estudos em artigos científicos relacionadas a condutas especiais do cirurgião bucomaxilofacial no período perioperatório de urgência e emergência. A justificativa é a possibilidade de infecção cruzada por meio da inalação de partículas produzidas durante os procedimentos cirúrgicos. A abordagem desse trabalho está relacionada à rota de transmissão e a possibilidade de contaminação cruzada da COVID-19 por meio de gotículas de salivas transformadas em aerossóis. Considera-se que a adoção de condutas especiais no período periorperatório por parte do cirurgião bucomaxilofacial pode representar auxílio quanto a prevenção de transmissão do vírus tanto em relação aos profissionais quanto aos pacientes.Descritores: Infecções por Coronavírus; Assistência Perioperatória; Aerossóis; Transmissão de Doença Infecciosa do Paciente para o Profissional.ReferênciasShoji H, Fonseca EKUN, Teles GBDS, et al. Structured thoracic computed tomography report for COVID-19 pandemic. Einstein (Sao Paulo). 2020;18:eED5720.Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020;24(4):1619-21.Rodrigues MFB, Rocha LLDA, Acioly RDF, Souza DDD, Carvalho DDC, Rocha RCLD, Rocha CCLD. Special precautions in oral and maxillofacial surgeries regarding COVID-19 transmission. Preprints 2020, 2020050135 (doi: 10.20944/preprints202005.0135.v1).To KKW, Tsang OTY, Leung WS, Tam AR, Wu TC, Lung DC et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20(5):565-74.Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod. 2020;46(5):584-95.Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. J Dent Res. 2020;99(5):481-87.Ge ZY, Yang LM, Xia JJ, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020;21(5):361-68. Wang WK, Chen SY, Liu IJ, Chen YC, Chen HL, Yang CF et al. Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis. Emerg Infect Dis. 2004;10(7):1213-19.Chang L, Yan Y, Wang L. Coronavirus Disease 2019: Coronaviruses and Blood Safety. Transfus Med Rev. 2020;34(2):75-80.Spagnuolo G, De Vito D, Rengo S, Tatullo M. COVID-19 Outbreak: An Overview on Dentistry. Int J Environ Res Public Health. 2020;17(6):2094.Zucco L, Levy N, Ketchandji D, Aziz M, Ramachandran SK. Considerações perioperatórias para o novo coronavírus 2019 (COVID-19). Rochester: ASPF; 2020.Abosadegh MM, Saddki N, Al-Tayar B, Rahman SA. Epidemiology of maxillofacial fractures at a tea- ching hospital in Malaysia: a retrospective study. BioMed Res Int. 2019: 9024763.Colégio Brasileiro de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF). COVID-19 - Guia de Práticas em CTBMF. Disponível em: https://www.bucomaxilo.org.br/site/noticiasdetalhes.php?cod=344amp;q=COVID19%2B%20%2BGuia%2Bde%2BPr%C3%A1ticas%2Bem%2BCTBMFamp;bsc=ativar. Acesso em: 07 de abr. de 2020.American Association of Oral and Maxillofacial Surgeons (AAOMS). Member Alert: COVID-19 Guidance for OMS Practices. Disponível em: https://www.aaoms.org/news/member-alert-covid-19-guidance-for-oms-practices. Acesso em: 10 de fev. de 2020.AOCMF International Task Force Recommendations on Best Practices for Maxillofacial Procedures during COVID-19 Pandemic. Disponível em: https://aocmf3.aofoundation.org/-/media/project/aocmf/aocmf/files/covid-19/ao_cmf_covid-19_task_force_guidelines.pdf. Acesso em: 10 de fev. de 2020.

Abstract Purpose To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment. Methods A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment. Results A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7–99.3), a specificity of 38.6 (35.0–42.3), and a negative predictive value of 99.3 (97.3–99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6–100.0), a specificity of 39.1 (33.2–45.4), and a negative predictive value of 100.0 (96.1–100.0). Conclusion The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future. Trial Registration The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

Introduction Displacement of foreign bodies into the maxillary sinuses during dental procedures is a rare entity. The most common causes are the iatrogenic dental procedures and the maxillofacial trauma respectively, according to the literature. The aim of this article is to present a case series of foreign bodies displacement into the maxillary sinuses due to iatrogenic dental procedures. Material and Methods Detection of the foreign bodies into the maxillary sinuses was achieved with radiologic methods and confirmed intraoperatively or later with the histopathology report. Minimal invasive procedure was the treatment of choice in all cases. Results Our study included 27 patients, 17 males and 10 females with mean age of 46.14 years (SD 10.35, range 18-65 years). The displacement of foreign bodies into the maxillary sinus concerned to fragments of teeth in 11 patients (40.27%), whole teeth in 4 (14.81%), dental implants in 5 (18.51%), dental impression materials in 2 (7.4%), endodontic treatment materials in 4 (14.80%) of which 2 associated with aspergillosis, fractured or not dental burs in 1 (3.7%). The occurrence of paranasal sinusitis due to foreign bodies displacement into the maxillary sinuses is time-dependent, the faster the treatment the better the outcome. Discussion Development of paranasal sinusitis due to displacement of foreign dental bodies into the maxillary sinuses is the physical outcome. Early surgical treatment is the key factor for to avoid sinusitis or minimize its occurrence.

A osteoporose é responsável por causar condições devastadoras no tecido ósseo elevando o risco de fraturas, constituindo uma problemática importante de saúde pública. É comum o uso de medicamentos, como os bifosfonatos para o controle dessa patologia. Contudo, a associação do uso desse medicamento com a osteonecrose dos maxilares vem sendo amplamente discutido na literatura, assim como a dificuldade da reabilitação desses pacientes como implantes e do protocolo de tratamento dessa condição. Assim sendo, o objetivo do presente trabalho foi realizar uma revisão de literatura para discutir as principais falhas associadas a instalação de implantes em pacientes portadores de osteonecrose dos maxilares associada ao uso de bifosfonatos (OMAB), assim como as possibilidades de tratamento, e relatar um caso clínico. As informações obtidas na revisão nos permitiu concluir que o uso de bifosfonatos orais, como o alendronato, é capaz de levar ao desenvolvimento da OMAB sendo necessária bastante precaução na reabilitação oral com implantes dentários, tanto em pacientes que fazem uso, como pacientes que apresentam risco de futura utilização de bifosfonatos para o tratamento de desordens esqueléticas. Descritores: Osteoporose; Alendronato; Osteonecrose; Implantes Dentários.ReferênciasEsposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. Eur J Oral Sci. 1998;106(1):527-51.Quirynen M, De Soete M, Van Steenberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res. 2002;13(1):1-19.Van Steenberghe D, Jacobs R, Desnyder M, Maffei G, Quirynen M. The relative impact of local and endogenous patient‐related factors on implant failure up to the abutment stage. 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