The diagnostic value of Computed Tomography in evaluation of maxillofacial Trauma
The diagnostic value of Computed Tomography in evaluation of maxillofacial Trauma
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计算机断层扫描在颌面部外伤评估中的诊断价值
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发表时间：
2012
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通讯作者：
Q. H. Muassa
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作者：
Q. H. Muassa
目前，CT扫描在评估和处理创伤受害者方面已经确定了一个明确的地点。这项复杂的调查的诊断结果往往远远超过仅从临床检查和标准化放射学中所能预期或怀疑的结果。本研究的目的是评价CT检查在面部创伤中的作用。样本(78例)，不同性别的面部创伤主诉患者为研究对象。CT扫描显示92例骨折位于不同部位。43例(46%)采用冠状切面，最常见的骨折部位为颧骨(32例，34.7%)。CT检查对眼眶、面中部、鼻筛区等面骨提供了充分的X线评价，但对除下颌骨外的其他部位，CT检查不会比常规影像增加更多的信息。导言。颌面部是人体中最复杂的区域之一，创伤患者由于临床条件和合作能力的限制，该区域的成像变得更加困难。由于本已复杂的解剖框架(1，2)的扭曲和破坏，在颌面部损伤中获得的常规X线片可能不容易解释。尽管存在辐射风险，但计算机断层扫描(CT)具有提供面部骨骼薄片图像的优势，克服了普通X光照片不可避免地出现结构重叠的问题。此外，与普通胶片的模拟信息相反，信息的数字采集允许通过改变设置来电子处理数据，以提供骨窗水平的图像或用于最佳软组织评估。这种增强的对比敏感度也改善了对各种异物的可视化(3)。随着计算机技术和数字放射图像诊断技术的进步，使用专门的软件程序来改进对放射图像的解释、调整和存储成为可能。现在，计算机断层扫描(CT)在评估和管理创伤受害者方面已经确立了明确的位置。这项复杂的调查的诊断结果往往远远超过临床检查和标准化放射学的预期或怀疑(2)，这一观点得到了该领域其他工作者的支持。(4、5、6)。因此，这项研究的目的是评估CT扫描作为一种诊断工具在伊拉克患者面部创伤处理中的作用。材料与方法选择2006-03/2007-03在AL-Hilla教学医院颌面外科就诊的患者46例，均为不同性别，均有不同程度的面部损伤。来自苏莱曼州教学医院颌面外科的32例患者也纳入相同目的的研究，因此患者总数为78例，年龄19~58岁。库法医学杂志2009.VOL.12.No.1252经初步评估和临床检查后，根据以下标准选择患者进行CT扫描：根据高级创伤生命支持(ATLS)无需急救。面部多发伤或严重毁容患者。有颅面或颈部损伤的患者。在配合病人或改变意识水平。面部上1/3外伤或眼眶损伤的患者。面部骨的CT检查根据损伤部位和CT检查的类型，对所有病例进行CT检查。轴位与眶中线平行，冠状面与眶中线成约6090度角。连续切片穿过创伤性区域，5 mm厚的层厚用于特殊复杂解剖细节区域或严重创伤患者，如鼻甲、眼眶或LeFort骨折。对下颌骨或颧骨骨折采用5~10 mm的切片进行检查。对于颅面复合伤，颅脑采用10 mm厚的切片，面骨采用5 mm厚的切片。所有CT检查均在显示器上以多窗口放大模式进行回顾，这将对图像进行修改，以便更好地诊断和鉴别硬、软组织损伤。无花果。(1)轴位CT显示。(2)颧骨髁状突骨折的冠状位CT表现。向后移位。
A definite place has now been established for the computed tomography (CT) scanning in assessment and management of trauma victims. The diagnostic return of this sophisticated investigation was often far greater than could be expected or suspected from clinical examination and standardized radiology alone. The purpose of this study was to evaluate the role of CT examination in facial trauma. Sample (78) patients of different sexes complaining from facial trauma were included in this study. CT scan showed (92) fractures in these patients in different sections. Coronal sections were used in (43) cases (46%) and the most common fracture was the zygomatic bone (32) case (34.7%). The CT examination provide adequate radiographic assessment for facial bones like Orbit, midface and nasoethmiod region while it will not add more information than conventional imaging in mandibular area except the condyle area. Introduction. The maxillofacial region is one of the most complex areas in the human body and the imaging of this region become even more difficult in traumatized patients because of their clinical condition and inability to cooperate. Conventional radiographs obtained in the maxillofacial injuries may be not easy to interpret, owing to the distortion and disruption of an already complex anatomical framework (1, 2). Although there is a risk of radiation, computed tomography (CT) scan has the advantage of providing images of thin slices of the facial skeleton, overcoming the problem of the superimposition of structures that inevitably occurs on plain radiographs. Furthermore, the digital acquisition of information, as opposed to the analogue information of plain films, allows electronic manipulation of the data by altering the settings to provide images either at bony window levels or for optimal soft tissue evaluation. This increased contrast sensitivity also provides improved visualization of a wide variety of foreign bodies (3). Advances in diagnostic techniques with computer technology and digital radiographic images offered the possibility for improvement of interpretation, adjustment and storage of the radiographic images using dedicated software programs.A definite place has now been established for the computed tomography (CT) scanning in assessment and management of trauma victims. The diagnostic return of this sophisticated investigation was often far greater than could be expected or suspected from clinical examination and standardized radiology alone (2), this view has been supported by other workers in this field. (4, 5, 6). Thus the purpose of this study was to assess the role of CT scan as a diagnostic tool in management of facial trauma in a sample of Iraqi patients. Materials and Methods During the period from March 2006 to March 2007 , (46) patients from different sexes presented to the department of maxillofacial surgery , AL-Hilla Teaching Hospital with variety of facial injuries were included in this study . Another (32) patients from department of maxillofacial surgery , Teaching Hospital of Sulaimania also included in the study for the same purpose so the total number of the patients were (78) whose ages ranged from 19-58 years. Kufa Med.Journal 2009.VOL.12.No1. ___________________________ 252 Criteria of Selection of the Patients After initial assessment and clinical examination the following criteria were used to select the patients for CT scanning: No emergency treatment is needed according to the advance trauma life Support (ATLS).Patients with multiple facial injuries or sever facial disfigurement. Patients with craniofacial or cervical injuries. In cooperate patients or altered in the level of consciousness. Patients with trauma to upper third of the face or orbital injury. CT Examination of the Facial Bones The CT scan were arranged for all cases according to the injured area and the type of CT examination. The axial section was parallel to the orbitomeatal line while the coronal section was angled about 6090 degree from the orbitomeatal line. A contiguous slices were performed through the traumatized area, (5mm) slice thickness were used in the regions of particular complex anatomical details or severely injured patients like nasoetmoid , orbital or LeFort fractures. Otherwise (5-10mm) sections were used for examination of mandibular or zygomatic fractures. For combined craniofacial injuries (10mm) slice thickness was used for brain injuries and (5mm) section used for the facial bones. All CT examination was reviewed on the monitor with magnification mode at multiple windows level this will modify the image for best diagnosis and differentiation between hard and soft tissues injuries. Fig. (1) : Axial CT show Fig.(2) : Coronal CT of condylar fracture of zygoma which fracture . displaced posteriorly.