Diagnostic Accuracy of Maxillofacial Trauma Two-Dimensional and Three-Dimensional Computed Tomographic Scans: Comparison of Oral Surgeons, Head and Neck Surgeons, Plastic Surgeons, and Neuroradiologists

• DOI: 10.1097/prs.0b013e318213a1fe
• Publication Date: 2011-05-27T11:55:32Z
• Authors: Reza Jarrahy; Victoria Vo; Haig A. Goenjian; Christina J. Tabit; Hurig V. Katchikian; Anand Kumar; Clifton Meals; James P. Bradley
• Keywords: Observer Variation; Surgery, Oral; 03 medical and health sciences; Imaging, Three-Dimensional; 0302 clinical medicine; Neuroradiography; Humans; Maxillofacial Injuries; Clinical Competence; Diagnostic Errors; Surgery, Plastic; Tomography, X-Ray Computed; Head; Neck

The authors' objectives were to study differences in diagnostic accuracy between two- and three-dimensional computed tomographic scans and among the specialties of plastic surgery, head and neck surgery, oral surgery, and neuroradiology, since this had not previously been done.Four groups of subspecialists completed time-proctored tests of 20 maxillofacial trauma scans with zygomatic arch, zygomatic complex, orbital, Le Fort I, II, III, mandibular and panfacial fractures from five institutions (n = 40). Accuracy of diagnosis and indication for surgery, efficiency, and preference were assessed. Comparison between two- and three-dimensional scans, between expert (experienced attending) versus novice (resident/fellow), and among the four subspecialties was performed.For two- and three-dimensional scans, two-dimensional was more accurate for orbital floor/medial wall (40 percent and 34 percent) and frontal sinus (26 percent for diagnostic) fractures. Two-dimensional examinations took 2.3 times longer but were preferred (85 percent). Experts and novices had similar accuracy with three-dimensional scanning, but experts were more accurate with the two-dimensional scanning. Experts were 3.3 times faster with two-dimensional scanning but not with three-dimensional scanning. Accuracy of diagnosis among subspecialists was similar, except that oral surgery was less accurate with orbitozygomatic fractures (79 percent versus 90 to 92 percent); neuroradiology was less accurate with indications for surgery (65 percent versus 87 to 93 percent).Differences in diagnostic accuracy exist between two- and three-dimensional maxillofacial scans and between expert and novice readers but not between subspecialties. Combined modalities are preferred.