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Radiological diagnosis of mandibular fracture
  1. Piraya Begum1,
  2. Steve Jones2
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
  2. 1Medical Student
  3. 2Research Fellow
  1. Kevin Mackway-Jones, Consultant (e-mail: kmackway{at}fs1.mci.man.ac.uk)

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Report by Piraya Begum; Search checked by Steve Jones

Clinical scenario

A 24 year old man presents to the emergency department on Saturday night with injuries to his lower jaw. He has been involved in a fight. On examination there is extensive bruising to the left side of the face and chin. The patient is unable to open his mouth or talk due to pain and trismus. You suspect a mandibular fracture and decide to x ray the mandible. You wonder whether a standard mandibular series or a panoramic view is the best technique for accurately detecting any fracture.

Three part question

In [adult patients with mandibular trauma] are [panoramic radiographs better than the standard mandibular series] at [accurately diagnosing fractures]?

Search strategy

Medline 1966 to 10/99 using the OVID interface. [({exp fractures OR fracture$.mp} AND {exp mandible OR mandible$.mp or mandibular.mp}) OR exp mandibular fractures] AND {exp radiography OR x-ray$.mp OR roentgen$.mp} AND {exp radiography, panoramic OR orthopantomogram.mp OR OPG.mp} LIMIT to human AND english.

Search outcome

Sixty four papers were found of which 60 were irrelevant or of insufficient quality for inclusion. The four remaining papers are shown in table 1.

Table 1

Comment

None of the studies offer good evidence to answer the question. All are small, poorly designed and study only patients with fractures. All, except the last, suggest that there is some diagnostic advantage in using orthopantomography (OPG), but reinforce the view that OPG alone is not sufficiently sensitive to be used as a SnOut. Further well designed diagnostic studies in the correct spectrum of patients are needed.

Clinical bottom line

Adult patients with suspected mandibular fractures should have OPG as a screening radiograph. If no fracture is seen but clinical suspicion remains high then further views should be obtained.

Report by Piraya Begum; Search checked by Steve Jones

References

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