Imaging Modalities for Jaw Fractures

Primary Imaging Options

The American College of Radiology recommends CT with multiplanar reformations as the best imaging modality for jaw fractures, offering nearly 100% sensitivity with improved interobserver agreement compared to conventional radiography 1, 2
CT maxillofacial provides superior delineation of osseous and soft-tissue structures with high image resolution, allowing detection of subtle nondisplaced fractures 1, 2
CT maxillofacial is nearly 100% sensitive for mandibular fractures with improved interobserver agreement compared to conventional radiography 1
Orthopantomogram (OPG) may be appropriate in patients with low clinical suspicion of injury, with a sensitivity of 86% to 92% for simple mandibular fractures 1, 2
OPG has limitations, including missing nondisplaced and minimally displaced anterior fractures due to overlap with cervical spine, and poor visualization of mandible condyle and subcondylar fractures with anterior displacement 1, 2, 3

20-40% of patients with mandibular fractures have additional injuries, including intracranial injuries (39% of mandibular fracture patients) and cervical spine injuries (approximately 11% of patients) 3, 5, 6, 7, 8
The American College of Radiology suggests considering additional imaging based on mechanism of injury and clinical findings 5, 8

Mandibular fractures often occur in pairs (67% of cases) due to the U-shaped configuration of the mandible, and common patterns include mandibular angle/subcondylar fracture with contralateral parasymphyseal fracture and flail mandible (bilateral subcondylar fractures with symphyseal fracture) 6