Imaging of Mandibular Trauma: ROC Analysis

Objectives: To compare the diagnostic efficacies of panoramic radiographs, mandibular trauma series, and digitized radiographs for detection of fractures of the mandible. Methods: Fractures were induced using blunt trauma in 25 cadaver mandibles. Panoramic radiographs, digitized radiographs, and mandibular series comprising an anteroposterior view, two lateral oblique, and a reverse Towne's were used. Six observers recorded their diagnoses using a five‐point confidence rating scale. The data were analyzed using receiver operating characteristic (ROC) curve analysis. Results: Significant differences based on imaging modalities were found (p < 0.0015) in the area under the curves (Az): panoramic radiograph, 0.8762; mandibular series, 0.7521; panoramic plus anteroposterior radiographs combination, 0.8886; and digitized mandibular series, 0.7723. No observer‐based differences were noted. Condylar and coronoid fractures were difficult to detect than those in other areas of the mandible (p < 0.033). Intra‐ and inter‐observer agreements were high (κw= 0.81 and 0.76, respectively). Conclusions: Panoramic radiographs are adequate for detection of mandibular fractures. Addition of an anteroposterior view augments diagnostic accuracy.