Best Imaging Modality for Jaw Fracture
CT with multiplanar reformations is the best imaging modality for jaw fractures, offering nearly 100% sensitivity with improved interobserver agreement compared to conventional radiography. 1
Primary Imaging Options
CT Maxillofacial (First-Line)
- Provides superior delineation of osseous and soft-tissue structures with high image resolution through thin-section acquisitions, allowing detection of subtle nondisplaced fractures 1
- Nearly 100% sensitive for mandibular fractures with improved interobserver agreement compared to conventional radiography 1
- Particularly valuable for posterior mandibular fractures, which are often missed on conventional radiographs 1
- Identifies fractures not visible on orthopantomogram (OPG), especially in the ramus or condyle regions where displacement can be subtle 1
- Critical for identifying comminution and displacement of mandibular fractures, which can change surgical management 1
- Offers multiplanar and 3D image reconstructions that allow better characterization of complex fractures and aid in preoperative planning 1
- Faster acquisition time than other modalities and less reliant on patient positioning than radiography 1
- First-line imaging for identifying penetrating foreign bodies and determining their trajectory 1
Orthopantomogram (OPG) - For Low Clinical Suspicion
- May be appropriate in patients with low clinical suspicion of injury 1
- Sensitivity of 86% to 92% for simple mandibular fractures, better than standard 4-view mandibular series (66% sensitivity) 1
- Limitations include:
- Missing nondisplaced and minimally displaced anterior fractures due to overlap with cervical spine 1
- Poor visualization of mandible condyle and subcondylar fractures with anterior displacement 1
- Risk of mistaking complex fractures for isolated fractures 1
- Requires patient to be upright, remain motionless, and have cervical spine clearance 1
- Better than CT for visualizing dental root fractures at certain angles 1
- Use has become less favorable in emergency and trauma care settings 1
MRI Maxillofacial (Limited Role)
- Not recommended as primary imaging for jaw fractures 1
- Only useful in specific scenarios:
- Diagnosing temporomandibular joint disc morphology and position in certain condylar fractures 1
- Evaluating cranial nerve deficits not explained by CT 1
- Assessing damage to the inferior alveolar nerve in fractures through the mandibular canal 1
- Detecting small pieces of asphalt as facial foreign bodies 1
Special Considerations
Cone Beam CT (CBCT)
- Emerging as a reasonable alternative to conventional CT for dentoalveolar and jaw trauma 2
- Offers advantages in radiation dosage, image quality, and patient comfort 2
- Can provide more detailed information about dentoalveolar fractures compared to conventional CT and radiography 3
Associated Injuries to Consider
- 20-40% of patients with mandibular fractures have additional injuries 1
- High association with intracranial injuries (39% of mandibular fracture patients) 1
- Cervical spine injuries found in approximately 11% of patients with mandibular fractures 1
- Consider additional imaging based on mechanism of injury and clinical findings 1
Clinical Pitfalls to Avoid
- Remember that mandibular fractures often occur in pairs (67% of cases) due to the U-shaped configuration of the mandible - always look for a second fracture 1
- Common patterns include:
- Do not rely solely on radiographs for complex fractures, as they may miss additional fracture lines 1, 3
- Be particularly vigilant in high-risk patients (>25 years old, especially men) with impacted third molars, as they are at increased risk for angle fractures 4
In summary, while orthopantomogram may be appropriate for cases with low clinical suspicion of injury, CT with multiplanar reformations is the imaging modality of choice for suspected jaw fractures, offering superior sensitivity, better characterization of fracture patterns, and critical information for surgical planning.