Diagnostic management of maxillofacial trauma patients: clinical considerations and radiological advancements

Maxillofacial trauma is a frequent cause for presentation at the emergency department. Maxillofacial trauma is often divided into midfacial or mandibular injury, and each of these regions are known for their characteristic and complex anatomy consequently leading to distinctive physical examination findings.Identification of maxillofacial fractures in an early stage of treatment is essential because of the potential functional and/or aesthetic consequences in case of delayed or lack of treatment. The first part of the thesis focusses on the diagnostic accuracy of physical examination finding for midfacial and mandibular fractures. We found that a simple clinical decision aid based on physical examination findings allows to reduce unnecessary CT scans in patient suspected of maxillofacial fractures. Also, another clinical decision aid safely rules out patients that require immediate surgical intervention.The second part of the thesis focuses on reducing radiation dose for patients that require a CT-scan of the maxillofacial region. The use of iterative reconstruction and deep learning algorithms substantially improve image quality of CT datasets. Moreover, the algorithms allow substantial reduction of the radiation dose while maintaining image quality.The combination of clinical decision aids and novel reconstruction techniques reduces the unnecessary use of CT scans and minimizes radiation exposure in patients that require radiological imaging of the maxillofacial region.

Dissertation: http://hdl.handle.net/11370/8ef44a21-1b9e-4ca2-ad41-1f5bf37f757e