How was that missed? (Trauma)

This week I have a case of trauma to the mandible and its radiographic appearance on 2D images versus 3D images.

This is a pantomograph of a patient presenting after trauma to the mandible (can’t remember exact type of trauma – fight, accident, etc.).  Take a look below to see what’s going on.

Most likely, the left mandibular fracture starting near the mandibular left premolar to the inferior border of the mandible is quite evident to you.  This case presented in a hospital so a CT scan was performed.  Check out the scout view below (viewed as if looking at the patient – your right is patients left and vice versa).

Notice something a miss on the patient’s ride side?  A vertical radiolucent line with separation of the body of the mandible from the ramus.

Now take a look back at the pantomograph in the right antegonial region.  There is a U shaped radiopacity evident.  This is an example of two fracture segments overlapping each other creating an area of increased radiopacity.  For more on the the 4 radiographic appearances of fractures check it out here.

Here is an axial view showing the fracture of the right angle of the mandible with the two segments overlapping each other.  If you look in the patients left premolar region, you can see the discontinuity of the more readily visible fracture on the pantomograph.

This case is just to remind you that there are a few ways that fractures appear on radiographs and to evaluate the entire radiograph carefully.

If you have any questions, please let me know. Thanks and enjoy!