Pantomography vs mandibular series for the detection of mandibular fractures

Objective: The two primary radiographic techniques used for the evaluation of mandible injury are a pantomographic series (PS) and the standard four-v iew mandibular series (MS). Despite a tenuous foundation, there is apparent bias in favor of PS compared with MS. Many emergency departments do not ha ve ready access to the specialized equipment necessary to perform a pantomo graphic study. The hypothesis of this study was that a high-quality standar d MS is as sensitive and specific as a PS in the detection of mandibular fr actures. Methods: This was a prospective, blinded study of 54 patients pres enting with acute mandibular injury comparing MS and PS. The study design u sed two board-certified emergency physicians and a single staff radiologist who read a series of MS and PS films in a randomized fashion without acces s to clinical information or identifying patient data. The absolute number of fractures present was determined by a neuroradiologist with access to bo th MS and PS simultaneously as well as pertinent clinical information. Resu lts: Thirty patients had 47 mandibular fractures. The sensitivity for fract ure detection for each physician was 0.85, 0.77, and 0.89 with MS and 0.79, 0.74, and 0.83 with PS (p greater than or equal to 0.51, p greater than or equal to 1.00, and p greater than or equal to 0.51, respectively, McNemar' s binomial test). The specificity for fracture detection for each physician was 0.88, 0.92, and 0.96 for MS and 0.96, 1.00, and 0.92 for PS (p > 0.625 , p > 0.50, and p = 1.00, respectively, McNemar's binomial test). Conclusio ns: A standard mandibular series is as sensitive and specific as pantomogra phy in the detection of mandibular fractures.