Frontobasilar fractures: Proposal for image reviewing algorithm |
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| Institution: | 1. Department of Otolaryngology – Head and Neck Surgery (Head: Prof. Reidar Grénman), Turku University Hospital and University of Turku, P.O. Box 52, FI–20521 Turku, Finland;2. Department of Otolaryngology – Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Finland;3. School of Science, Department of Industrial Engineering and Management, BIT Research Centre, Aalto University, Finland;4. Department of Radiology, Turku University Hospital and University of Turku, Finland;5. Department of Otolaryngology – Head and Neck Surgery, Oulu University Hospital and University of Oulu, Finland;6. Department of Radiology, Oulu University Hospital and University of Oulu, Finland;1. PO Box 808 L-281, Lawrence Livermore National Laboratory, Livermore, CA 94551, United States;2. General Atomics, San Diego, CA, United States;1. LMGC, UMR-CNRS 5508, Université Montpellier-2, case courier 048, place Eugène-Bataillon, 34095 Montpellier cedex 5, France;2. Department of Mathematics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand;3. Centre of Excellence in Mathematics, CHE, Bangkok 10400, Thailand;1. Department of Cranio-Maxillofacial Surgery, University Hospital of Bern (Inselspital), CH-3010 Bern, Switzerland;2. University Hospital of Child and Adolescence Psychiatry and Psychotherapy, Bolligenstrasse 111, CH-3000 Bern, Switzerland;3. Department of Emergency Medicine, University Hospital of Bern (Inselspital), CH-3010 Bern, Switzerland |
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| Abstract: | ObjectiveThe aim of this study was to develop and test the utility of a novel systematic protocol to analyze CT images of patients with trauma in the anterior cranial base and upper midface.Material and MethodsThe radiological data and primary reports of 27 consecutive patients with a frontal skull base fracture treated in two tertiary care hospitals from 2007 to 2011 were scrutinized. A novel algorithm for systematic image reviewing was used to assess the CT images and the findings were compared with the primary radiological reports.ResultsThe systematic review detected a substantial number of fractures and defects in anatomical structures that had not been systematically reported in the primary, on-call reports. Anterior skull base fracture was not initially reported in 32% of the patients; however, the algorithm detected this in 93% of them. The corresponding rates for fracture through cribriform plate were 28% and 72% and for fracture through the sella or hypophyseal area 22% and 78%. There were two fractures of the clivus and these were initially missed.ConclusionsDespite the failure to identify these fractures radiologically in the primary setting, all patients were still considered to have received appropriate treatment, but, the use of an image-reviewing algorithm will enhance the specificity of CT in the diagnosis of frontobasilar fractures. |
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| Keywords: | Maxillofacial surgery Trauma Computed tomography Algorithm |
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