ORIGINAL PAPERS. Revista Română de Anatomie funcţională şi clinică, macro- şi microscopică şi de Antropologie. Vol. XV Nr

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1 Revista Română de natomie funcţională şi clinică, macro- şi microscopică şi de ntropologie Vol. XV Nr ORIGINL PPERS The Utility of CCT Imaging Technique in Maxillofacial Trauma. Dobrovat 1, Roxana Popescu 1*, Manuela Ursaru 1,.H. Nedelcu 2, C.I. Stan 2, Danisia Haba 1 University of Medicine and Pharmacy Gr.T. Popa, Iasi 1. Department of Radiology and Medical Imaging 2. Department of natomy THE UTILITY OF CCT IMGING TECHNIQUE IN MXILLOFCIL TRUM (bstract): The retrospective study was conducted on the CCT evaluation of 23 patients (5 women and 18 men) who had fractures due to mild craniofacial trauma. Imaging scans were performed in a private imaging center in Iasi, with diagnostic purposes. It has used the machine Promax 3D MID (Planmeca Oy, Finland) characterized by an effective exposure time equal to 18 seconds, a resolution of 125 microm, a tube current of 5 m and a tube voltage of 80kV. From a total of 23 CCT exams 6 pacients had malar bone fractures, 7 mandible fractures, four fractures of the nose with minimum displacement, four fractures of the jaw and 2 of orbit. CCT exam can be quick and useful in diagnosis and therapeutic plannnigul of mild craniofacial trauma. Key words: CCT, TRUM, MXILLO-FCIL, DIGNOSIS INTRODUCTION Conical beam computed tomography (CCT) was developed in the early 1980s in order to serve the dental imaging (1). CCT produce a cone beam together with the plan detector performs a single gantry rotation acquiring volumetric acquisitions (3). Computer tomography volume is a modern alternative to conventional imaging diagnostic methods such as X-rays of the skull and computer tomography, which is characterized by high-resolution, making narrow sections of mm and viewing anatomic structures in the three planes: axial, coronal and sagittal (4 ). CCT is used as an imaging technique in oro-maxillo-facial surgery. The three-dimensional reconstructions provides relevant information for diagnosis in maxillofacial trauma and anatomic variations and abnomalies (5,6). MTERILS ND METHOD The retrospective study was conducted on the CCT evaluation of 23 patients that presented fractures due to craniofacial trauma. Imaging scans were performed in a private imaging center in Iasi, with diagnostic purposes. It has used the machine Promax 3D MID (Planmeca Oy, Finland) characterized by an effective exposure time equal to 18 seconds, a resolution of 125 microm, a tube current of 5 m and a a tube voltage of 80kV. Explorers were made respecting CCT scanning protocols, techniques parameters were selected differently, depending of patient age and body structure. ll dicom files generated by CCT investigation were visualized using software Romexis R (Planmeca, Helsinki, Finland). During examination the emitter-detector-unit rotates around the patient s head in 18 seconds. This creates 560 section width of 0,125mm. Using a software, sections of the region of interest are displayed on the PC monitor in three planes: coronal, axial and sagittal. The analysis of the exploration took into account the following parameters: headquarters of fractures, fractures type (linear without displacement, displaced or comminuted). The data obtained were processed using two programs dedicated to medical statistical analysis - SPSS 19.0 / 2010 for Windows and Microsoft Excel. 305

2 ogdan Dobrovat et al. Male Female Fig. 1 The distribution of patients by gender () and age group (). mandible nasal bones zygomatic maxilla orbit Fig. 2. Distribution of fractures by location; Distribution of mandibular fractures according to their location. RESULTS Patients age ranged from years in urban areas. Of the 23 patients, 5 were women and 18 men. From a total of 23 exams CCT 6 pacients had malar bone fractures, 7 had mandible fractures, four fractures of the nasal bones with minimum displacement, four fractures of the jaw and 2 of the orbit. The frequency of mandibular fractures was by location: 3 in the condyle, 2 in the angle of the jaw and one on the body and ascending branch of mandible (Figure 2). Distribution of fractures location by age is the following: For the age group years there were a mandibular condyle fracture and a fracture of the mandibular angle; For the age group years there were a mandibular angle fracture and a fracture of nazal bones; For the age group years were registered a mandibular condyle fracture, a fracture of the mandibular angle, four mandibular body fractures, three fractures of nazal bones and four zygomatic bone fractures; For the age group over 60 years there were two zygomatic bone fractures; Distribution of fractures location by sex is the following: For male patients fractures localions were: 2 in mandibular condyle, 3 in the angle of the mandible, 2 in mandibular body, 3 in nazal bones and 5 in zygomatic bone ; For female patients fractures localions were: 0 in mandibular condyle, 0 in the angle of the mandible, 2 in mandibular body, 1 in nazal bones and 1 in zygomatic bone; The frequency of fractures by type was as follows (Table I): 306

3 The Utility of CCT Imaging Technique in Maxillofacial Trauma Table I The frequency of fractures according to their type Valid Frequency Percent Valid Percent Cumulative Percent linear course of fracture without displacement 13 56,5 56,5 56,5 linear course of fracture with displacement 7 30,4 30,4 87,0 comminuted 3 13,0 13,0 100,0 Total ,0 100,0 C D Fig. 3. axial, sagittal and C coronary CCT sections- left mandibular third molar; D 3D CCT reconstruction suggests the presence of 3.8 relative to the fracture. Case 1. Pacient P.T, aged 25, has a fracture of the left mandible angle with 3.8 in the fracture. (Figure 3). Case 2. Patient male P.., aged 36, had a CCT examfor maxiillar trauma. nalysis of axial sections, panoramic oblique-axially and three-dimensional reconstructions show the presence of a fracture with displacement of the left sinus floor and a bone fragment in the left maxillary sinus (Figure 4, 5,6,7). 307

4 ogdan Dobrovat et al. Fig. 4. Panoramic topograma. Fig. 5. Paraxial sections, panoramic parts, placed at a distance of 1 mm. Fig. 6. 3D reconstructions showing the line of fracture. 308

5 The Utility of CCT Imaging Technique in Maxillofacial Trauma DISCUSSIONS Today, the CCT is most commonly used in orthodontics, implantology, endodontics and maxillofacial surgery (7,8). Currently in clinical practice, we can use 3D imaging to map and assess the massive facial fractures. lthough numerous studies have used and are still using classical Computer Tomography (9), Cone eam Computed Tomography (CCT) is gaining ground in assessing patients with mild craniofacial trauma. This is due to reduced cone beam X-ray machine size, dose of radiation, time required for scanning and discounted cost. ccording CCT technology, radiologists can provide a full and accurate diagnosis that can lead to an appropriate surgical planning. CONCLUSIONS CC can be a quick and useful method used in diagnosis and therapeutic planning of crani- Fig. 7. Coronal sections showing the bone fragment in maxillary sinus floor. ofacial trauma. This technique can be successfully applied in cases of mild craniofacial fractures and cracks and can help us to reduce the dose of radiation, costs and time required to achieve examinations. REFERENCES 1. Mozzo P, Procacci C, Tacconi, Martini PT, ndreis I. new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. European radiology, 8(9): , De Cock J, Mermuys K, Goubau J, Van Petegem S, Houthoofd, Casselman JW. Cone-beam computed tomography: a new low dose, high resolution imaging technique of the wrist, presentation of three cases with technique. Skeletal radiology,41(1):93-6, De Vos W, Casselman J, Swennen GR. Cone-beam computerized tomography (CCT) imaging of the oral and maxillofacial region: a systematic review of the literature. International journal of oral and maxillofacial surgery.38(6):609-25, Kim KD, Ruprecht, Jeon KJ, Park CS. Personal computer-based three-dimensional computed tomographic images of the teeth for evaluating supernumerary or ectopically impacted teeth. The ngle orthodontist. Epub, 73(5): , Fourie Z, Damstra J, Gerrits PO, Ren Y. ccuracy and reliability of facial soft tissue depth measurements using cone beam computer tomography. Forensic science international. Epub 199(1-3):9-14, Makris N, Stamatakis H, Syriopoulos K, Tsiklakis K, van der Stelt PF. Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone-beam computed tomography. Clinical oral implants research. Epub, 21(7): Qiu W, Tong JR, Mitchell CN, Marchant T, Spencer P, Moore CJ, et al. New iterative cone beam CT reconstruction software: parameter optimisation and convergence study. Computer methods and programs in biomedicine. Epub, 100(2):166-74, Palomo L, Palomo JM. Cone beam CT for diagnosis and treatment planning in trauma cases. Dental clinics of North merica. Epub, 53(4):717-27, Yoshida Y, Tokumori K, Okamura K, Yoshiura K. [Comparison of a dental cone beam CT with a multi-detector row CT on effective doses and physical image quality]. Nihon Hoshasen Gijutsu Gakkai zasshi. Epub, 67(1):25-33, Corresponding author Roxana Popescu drpopescuroxana@yahoo.com 309