Imaging Mandibular Fractures

Introduction

Mandible fractures are commonly seen in Emergency Departments. Imaging mandible fractures often raises the question of whether the imaging should include plain films, OPG or both. This page considers all aspects of plain film imaging of mandible fractures.

OPG or Plain Films?

Access to an OPG machine is undoubtedly useful in departments that treat patients with mandible trauma. The question arises as to which is the superior imaging approach- plain film or OPG? You could argue that an OPG is a type of tomogram and tomography should never be the first line of imaging. Equally there are cases where the OPG will demonstrate fractures clearly that are not seen on plain films. Conversely, the opposite is also true.

Should the OPG be the first line of investigation (like a screening tool) and the plain films employed as supplementary imaging or should the plain films be taken first and OPG employed to clarify any equivocal findings? The success of the plain films is also operator dependant- with a reduction in requests for plain film imaging of the skull and facial bones, many junior radiographers are not confident about their skull/facial bone plain film imaging skills.

Anatomy

<a class="external" href="http://emedicine.medscape.com/article/391549-overview" rel="nofollow" target="_blank">http://emedicine.medscape.com/article/391549-overview</a>

Case Study 1

	This 23 year year old man presented to the Emergency Department following a punch to his mandible. He was examined and found to be suffering pain and swelling over the left mandibular ramus. He was referred for radiography of his mandible. The right oblique view image demonstrates no displaced fracture.
	The left oblique view image demonstrates a fracture of the body of the mandible.
	The PA mandible image demonstrates a fracture the right mandibular ramus and a less obvious fracture of the left body of mandible
	The OPG demonstrates the left fracture clearly. The fracture of the right mandibular ramus is demonstrated but not as clearly as the left fracture.

Comment

This case demonstrates the limitations of the OPG in demonstrating mandible fractures. Although both fractures are visible, the right fracture is not obvious and the nature of the right ramus fracture (separation and displacement) is not clearly demonstrated. By contrast, the right ramus fracture could not be missed on the PA view image and the orientation, separation of fragments and displacement are clearly shown.

Case Study 2

	This 28 year old male presented to the Emergency Department after suffering a blow to the mandible during a team sports event. On examination, it was clear that he had suffered a mandibular fracture. The step in his lower dentition suggested the site of his mandibular fracture. He was referred for OPG and/or mandibular plain film imaging. The OPG image confirmed the mandibular fracture. The radiographer considered that there was likely to be a second fracture and proceeded to perform plain film imaging of the mandible.
	The patient reported pain and swelling on the right side of his face. The right oblique mandible projection did not reveal a second fracture.
	The PA mandible projection clearly demonstrated the second mandibular fracture through the right mandibular ramus.

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