The document discusses imaging for mandibular trauma. It states that helical CT is the gold standard for evaluating mandibular fractures, as it is highly sensitive. However, curved coronal CT scans, which provide views similar to panoramic x-rays but with the benefits of CT, may provide additional information without extra cost or time. The presenter proposes a study to evaluate whether curved coronal views help radiologists and surgeons better diagnose fractures and develop surgical plans compared to standard CT scans.

1. CURVED CORONAL
SCANS IN
MANDIBULAR
TRAUMA
Dr Rama Velamuri MD
Division of Plastic Surgery
Grand Rounds
St Louis University School of Medicine

2. •Mandibular fractures accounts for 36-60% of
maxillo-facial trauma
•Higher frequency in males 21-30 years
•Socioeconomic status/ alcoholism /environmental
factors

3. Imaging
Classify fractures
Anatomic Region Involved (Symphyseal/Body/Angle/
Ramus )
Alveolar/Mandibular Proper
Displaced/non displaced
Ramus Condylar-Intracapsular vs Extracapsular
Coronoid(muscular)
Formulation of Surgical Plan

4. Imaging Modalities
Conventional X Rays
Panorex
Spiral CT
3d Reformats
MRI(Nerve injuries)

5. Panorex
Zonogram
Gold standard for isolated mandibular trauma
Advantages:
Cost effective(180-400$)
Dental Evaluation
• Drawbacks:
Symphyseal/Parasymphseal
Technician Dependent
Poly trauma
C spine Injuries

6. Helical CT scan
Gold standard in Polytrauma
96-98% sensitive in Diagnosing mandibular
Fractures
1-2mm slices, Axial,coronal and sagittal
3d reformats

7. Questions?
Is Helical Ct the Gold standard?
Can we miss fractures or wrongly diagnose them?
Can any other form of imaging be helpful?

8. Curved coronal scans
Views Similar to Panorex with benefits of
Helical CT
No extra cost
No additional time
Available at St Louis university
Hospital(requisition to be filled out while
ordering it)

9. Patient 1

11. Curved coronal

13. Patient 2

14. Curved Coronal

16. Patient 3

17. C

18. Study Outline
Involve 2 Surgeons and 2 Radiologists
Evaluation of Ct scan before and after Curved coronal
view
Questionnaire
Did the imaging help change the diagnosis?
Did it give you more information about the
fracture?
Did it change your operative strategy?

19. References
A Single Reformatted Oblique Sagittal View as an Adjunct to Coronal Computed
Tomography for the Evaluation of Orbital Floor FracturesP. Angela Rake, DDS,* Scott A.
Rake, DMD,† James Q. Swift, DDS,‡ and Warren Schubert, MD§
Algorithm for Head Computed Tomography Imaging in Patients With Mandible Fractures
Marcin Czerwinski, MD,* Wendy L. Parker, MD, PhD, FRCS(C),† and H. Bruce Williams,
MD, FRCSC
Prospective Comparison of Panoramic Tomography (Zonography) and Helical Computed
Tomography in the Diagnosis and Operative Management of Mandibular FracturesIan F.
Wilson, M.D., M.P.H., Adam Lokeh, M.D., Charles I. Benjamin, M.D., Peter A. Hilger,
M.D., David D. Hamlar, M.D., Frank G. Ondrey, M.D., Joseph H. Tashjian, M.D., William
Thomas, Ph.D., and Warren Schubert, M.D.
Radiologic assessment of maxillofacial, mandibular, and skull base trauma Eur Radiol
(2005) 15: 560–568 DOI 10.1007/s00330-004-2631-7
Utility of Three-Dimensional and Multiplanar Reformatted Computed Tomography for
Evaluation of Pediatric Congenital Spine AbnormalitiesPeter O. Newton, MD,*† Gregory
W. Hahn, MD,‡ Kevin B. Fricka, MD,† and Dennis R. Wenger, MD*† SPINE Volume 27,
Number 8, pp 844–850 ©2002, Lippincott Williams & Wilkins, Inc.