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Neuroradiology Case of the Week

Case 366

December 2008

Daniel Ginat MD, MS and Per-Lennart Westesson, MD, PhD, DDS

Clinical Presentation: Patient is a 6-year-old male status post-head and face trauma during motor vehicle accident.

Imaging Findings: Non-contrast maxillofacial CT: Fracture of the buccal bone plate covering the two central and right lateral incisors (Fig. 1). Left central and left lateral deciduous teeth have been avulsed (Fig. 2).

Diagnosis: Maxillary buccal boneplate fracture

Discussion: Midfacial fractures most commonly result in the setting of motor vehicle accidents and assaults and have been increasing in incidence in recent years [1]. Maxillary fractures often occur in association with other fractures, such as in the case of LeFort, tripod fractures, and nasal complex fractures, for example. Alveolar fractures represent the most common type of isolated maxillary fracture [2]. The mechanism of injury may involve force transmitted from collision of the mandible with the incisors. The resulting outward tooth avulsion transmits an anteriorly-oriented force to the alveolar or buccal bone plate. A consequence of such an injury is tooth devitalization [2].
     Radiographic assessment of midface fractures have traditionally included panoramic and Water’s view. Spiral CT has superseded the role of X-ray for evaluating and classifying facial fractures [3]. In addition, MRI has an increasing role in evaluating the extent of soft tissue involvement, particularly in the presence of nerve palsies [1].

References:

1. Laine FJ, Conway WF, Laskin DM. Radiology of maxillofacial trauma. Curr Probl Diagn Radiol. 1993 Jul-Aug;22(4):145-88. [PubMed]
2. Som PM, Curtin HD. Head and Neck Imaging. 4th ed. Mosby, St. Louis, 2003.
3. Schuknecht B, Graetz K. Radiologic assessment of maxillofacial, mandibular, and skull base trauma. Eur Radiol. 2005 Mar;15(3):560-8. [PubMed]