J Korean Assoc Oral Maxillofac Surg.  2018 Feb;44(1):18-24. 10.5125/jkaoms.2018.44.1.18.

Comparison of accuracy between panoramic radiography, cone-beam computed tomography, and ultrasonography in detection of foreign bodies in the maxillofacial region: an in vitro study

• Abdinian M
• Aminian M
• Seyyedkhamesi S

• KMID: 2405372
• DOI: http://doi.org/10.5125/jkaoms.2018.44.1.18

Abstract

OBJECTIVES
Foreign bodies (FBs) account for 3.8% of all pathologies of the head and neck region, and approximately one third of them are missed on initial examination. Thus, FBs represent diagnostic challenges to maxillofacial surgeons, rendering it necessary to employ an appropriate imaging modality in suspected cases.
MATERIALS AND METHODS
In this cross-sectional study, five different materials, including wood, metal, glass, tooth and stone, were prepared in three sizes (0.5, 1, and 2 mm) and placed in three locations (soft tissue, air-filled space and bone surface) within a sheep's head (one day after death) and scanned by panoramic radiography, cone-beam computed tomography (CBCT), and ultrasonography (US) devices. The images were reviewed, and accuracy of the detection modalities was recorded. The data were analyzed statistically using the Kruskal-Wallis, Mann-Whitney U-test, Friedman, Wilcoxon signed-rank and kappa tests (P < 0.05).
RESULTS
CBCT was more accurate in detection of FBs than panoramic radiography and US (P < 0.001). Metal was the most visible FB in all of modalities. US was the most accurate technique for detecting wooden materials, and CBCT was the best modality for detecting all other materials, regardless of size or location (P < 0.05). The detection accuracy of US was greater in soft tissue, while both CBCT and panoramic radiography had minimal accuracy in detection of FBs in soft tissue.
CONCLUSION
CBCT was the most accurate detection modality for all the sizes, locations and compositions of FBs, except for the wooden materials. Therefore, we recommend CBCT as the gold standard of imaging for detecting FBs in the maxillofacial region.

Keyword

Foreign bodies; Panoramic radiography; Cone-beam computed tomography; Ultrasonography; Maxillofacial region

MeSH Terms

Cone-Beam Computed Tomography*
Cross-Sectional Studies
Foreign Bodies*
Glass
Head
In Vitro Techniques*
Neck
Oral and Maxillofacial Surgeons
Pathology
Radiography, Panoramic*
Tooth
Ultrasonography*
Wood

Figure

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  Fig. 1 Materials used as foreign bodies (from left to right: stone, glass, tooth, metal, and wood).

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  Fig. 2 A. Panoramic radiography view of 2 mm metal (left) and 2 mm stone (right) on bone surface. B. Cone-beam computed tomography sagittal view of 2 mm metal in air-filled space (upper arrow) and 1 mm tooth fragment in soft tissue (lower arrow). C. Ultrasonography view of 2 mm wood in soft tissue (arrow).

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  Fig. 3 Detection accuracy of panoramic radiography, cone-beam computed tomography (CBCT) and ultrasonography (US) for different type of foreign bodies (FBs).

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  Fig. 4 Detection accuracy of panoramic radiography, cone-beam computed tomography (CBCT) and ultrasonography (US) for different size of foreign bodies (FBs).

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  Fig. 5 The accuracy of the panoramic radiography, cone-beam computed tomography (CBCT) and ultrasonography (US) in detection of foreign bodies (FBs) in different locations.

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