Assessment of maxillary fracture risk using classification of the mandibular inferior cortical shape by pantomography

Abstract

Maxillofacial injuries remain a serious clinical problem because of the maxilla’s anatomical significance, with important organs, including the beginning of the digestive and respiratory systems, located in this area. The purpose of this study was to assess the risk of maxillary fracture by classification of the mandibular inferior cortical shape using pantomography. This prospective study was approved by the Institutional Review Board (EC15-12-009-1). Three-hundred and sixty-four patients (190 males, 174 females; age 20 - 91 years, mean age 48.0 years) with suspected maxillary fractures who underwent both pantomography and multidetector row computed tomography (MDCT) from April 2011 to December 2016 were included in this study. The mandibular inferior cortical shape was evaluated by pantomography on both sides of the mandible, distal to the mental foramen by specialist of two oral and maxillofacial radiologists, and classified into three types as follows; Type l: normal cortex, Type 2: mildly to moderately eroded cortex and Type 3: severely eroded cortex. Moreover, the patients were divided into two groups; Group I: normal bone mineral density (Type 1) and Group II: low bone mineral density (Types 2 and 3). The presence of maxillary fractures and the classification of the mandibular inferior cortical shape were compared using pantomography. Of the 364 patients, fractures were seen in 219 patients (60.2%). Of the 219 patients with maxillary fractures, 51 patients were in Group I (23.3%) and 168 patients were in Group II (76.7%). Of the 145 patients without maxillary fractures, 120 patients were in Group I (82.8%) and 25 patients were in Group II (17.2%). There was a statistically significant difference between Groups I and II in the prevalence of maxillary fractures (p<0.05). Our results suggest that classification of the mandibular inferior cortical shape using pantomography may provide a risk assessment for maxillary fracture.