Validade dos cortes axiais e reconstruções coronal, sagital e em três dimensões no diagnóstico das fraturas do terço médio da face

Abstract

Multiple fractures of the midface exhibit a complex and difficult diagnosis to be made because the patient`s clinical status at the time of admission. CT scans have been very important in the successful treatment of patients, avoiding delays and unforeseen events during the surgical procedure and postoperative sequelae. Therefore, it is necessary to real knowledge of the indications to take advantage of the benefits for diagnosis, planning and development of the case, without further loss to the hospital, mainly for professional and patient.This study aims to establish the value of axial slices and three types of computadorized tomography reconstructions (sagittal, coronal and three dimension - 3D) to diagnose third midfacial fractures. Tomography images of 65 patients were evaluated in order to assess facial fractures. These images were obtained from 64 channels multislice SOMATON SENSATION (SIEMENS).The tomography protocol for bone tissue was: slice of 1,0 mm of width with 0,5mm interval, 120kVp, 150 mA, pattern of 512x512 pixel. The images were evaluated by Syngo FastView program. The data was based on ID sheet for facial fractures which was specific for Oral and Maxillofacial surgeons and a Radiologist specialist. Then, it elaborates 4 hypothesis after a) evaluation of axial slices, b) sagittal reconstruction, c) coronal reconstruction and d) 3D reconstruction. The gold standard was a clinical-surgical hypothesis which was done for another Oral and Maxillofacial surgeon who performed surgical procedures on these patients. Some tests were done to evaluate the levels of data from axial slices, multi field reconstructions and 3D reconstruction to get a correct diagnostic hypothesis. The tests used were Kappa index, the sensitivity, the specificity, positive and negative predictive value and the accuracy. The best results were achieved using the 3D reconstruction in all midfacial fractures, while the sagittal reconstructions had the least significant results in diagnosis these fractures. The coronal reconstructions showed greater validity than the axial slices to diagnose in orbital fractures (superior, medial walls and floor), nasal and palate fractures. On the other hand, axial slices were more valuable in other fractures such as frontal sinus fractures, orbital lateral wall fractures and zygomatic arch fractures. 12 The similar accuracy was observed on the maxillary sinus fractures using axial slices and coronal reconstruction. The tomography protocol used on this study is indicated to diagnose midfacial fractures.