This document discusses the use of radiographic examination in evaluating maxillofacial trauma. It outlines various projections and views useful for fractures in different areas of the face. It also describes radiographic signs that indicate fractures and indirect signs like soft tissue swelling. While radiography is useful, it must be interpreted carefully alongside a clinical examination. The accurate diagnosis provided by radiography, along with recent advances like spiral CT, allow for effective treatment planning in maxillofacial trauma.

1. RADIGRAPHIC EXAMINATION
IN MAXILLOFACIAL TRAUMA

2. Radiological examination
 Useful diagnostic aid.
 Radiation cost
 Financial cost
 Urgency of the treatment.

3. Projections for facial fractures
 For fractures of middle third of the face
- Occipitomental view
- Submentovertex view
- Lateral skull
- PA view – water’s position

4.  For zygomatic complex fracture
- Occipitomental view
- Submentovertex view
- PA view – water’s position
 For mandibular fractures
- OPG
- Right & left lateral oblique view of
mandible
- PA view of mandible

5. Radiological interpretation of
facial trauma
You see what you look for…!!!!

6.  Occipitomental projection
 Fractures & other signs are
commonly found.
Campbell’s and trapnell’s lines

7. Dolan & Jacoby’s line
A) Orbital line.
B) Zygomatic line.
C) Maxillary line.

8. 4 ‘S’ by Delbalso et al
 Symmetry.
 Sharpness – Bright sign, Trapdoor sign.
 Sinus.
 Soft tissues.
foreign bodies, emphysema.

9. HOT sites of fracture on
face.

10. Radiographic signs of fracture.
 Separation sign.
 Sutural diastasis.
 Overlap sign.
 Abnormal linear density
 Disappearing fragment sign.
 Abnormal angulation.
 Step deformity

11. Indirect signs.
 Soft tissue swelling.
localized – attention to that part
 Paranasal sinus opacification.
 Air in the soft tissues.

12. CT scan
 Provides images in thin slices,
avoid superimposition of
structures.
 Increased contrast- foreign
bodies.
 Axial CT scan – transverse
plane.
 Coronal CT scan – orbital
examination

13.  MRI- soft tissue injury, CSF leak.
Recent advances
 Spiral & Multislice CT
- Much faster & can provide 9
times larger image.
- High quality reconstruction.
 3D CT scan.
 Angiography,
arthrography.

14. Conclusion.
Surgical
outcome
Treatment
planning
Accurate diagnosis
Careful clinical examination

15. References.
 Oral & maxillofacial trauma- Fonseca,vol 1
 Maxillofacial Injuries- Rowe & Williams
 Textbook of oral & maxillofacial surgery by Peter
Ward Booth.