The  Role of Conventional Radiographs and 3D CT in the Evaluation of Maxillofacial Trauma: A Systematic Review

Samra Bokhari; Nauman  Shirazi; Samir Azeem  Qadri; Tauseef  Ahmed; Muhammad Khalil  Khan

doi:10.36283/ziun-pjmd14-3/080

Authors

Samra Bokhari National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan.
Nauman Shirazi Karachi Medical and Dental College, Karachi Metropolitan University, Pakistan.
Samir Azeem Qadri Liaquat College of Medicine and Dentistry, Karachi Pakistan.
Tauseef Ahmed Liaquat College of Medicine and Dentistry, Karachi Pakistan.
Muhammad Khalil Khan Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan.

DOI:

https://doi.org/10.36283/ziun-pjmd14-3/080

Keywords:

Maxillofacial trauma, radiography, tomography, x-ray computed, three-dimensional imaging, Diagnostic Imaging

Abstract

Background: Maxillofacial injuries are a frequent occurrence in emergency clinical settings, posing diagnostic challenges that require both rapid and accurate assessment to facilitate appropriate treatment planning. Traditionally, conventional radiographs have served as the first-line imaging modality for evaluating facial trauma. However, the introduction of three-dimensional computed tomography (3D CT) has provided an alternative diagnostic tool, offering enhanced visualization of complex anatomical structures and potentially greater diagnostic accuracy. This systematic review aimed to critically evaluate and compare the diagnostic effectiveness and clinical utility of conventional radiographs versus 3D CT in assessing maxillofacial trauma.

Methods: A systematic search was carried out using Google Scholar and PubMed to explore the comparative diagnostic performance of advanced imaging modalities—such as multidetector CT (MDCT), cone-beam CT (CBCT), and lateral cephalograms—against conventional radiographs for evaluating maxillofacial trauma and anatomical structures. Initially, 10,739 articles were retrieved using broad search terms including “maxillofacial trauma,” “3D CT,” “CBCT,” “orthopantomogram,” and “diagnostic accuracy.” Filters were then applied to limit the results to studies published between 2020 and 2025, resulting in 2,986 articles. After excluding review articles and case reports, and applying criteria to include only English-language, original human studies, a final selection of 3 relevant articles was made.

Results: Findings across the selected studies consistently demonstrated the enhanced diagnostic value of 3D imaging techniques compared to traditional 2D radiographs. In trauma cases, multidetector CT and CBCT provided more detailed visualization of fracture lines, displacement, and sinus involvement. One study highlighted that 3D reconstructions offered clearer insight into maxillary and mandibular fractures than axial or sagittal slices alone. Another study utilized CBCT-based cephalograms to assess sinus morphology, revealing statistically significant differences in maxillary sinus volume between male and female patients, with potential applications in forensic identification. These advanced imaging tools not only improved sensitivity but also offered greater measurement accuracy and anatomical clarity.

Discussion: Overall, this review supports the clinical utility of MDCT and CBCT as superior diagnostic options in the assessment of maxillofacial injuries and structural variations. Compared to conventional radiographic methods, three-dimensional imaging delivers clearer, more accurate visualizations, aiding in both clinical diagnosis and forensic applications. Their precision in detecting complex fractures and anatomical differences positions them as the preferred imaging choice in contemporary dental and maxillofacial practice.

Author Biographies

Samra Bokhari, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan.

Department of Orthodontics,
Nauman Shirazi, Karachi Medical and Dental College, Karachi Metropolitan University, Pakistan.

Department of Oral Biology,
Samir Azeem Qadri, Liaquat College of Medicine and Dentistry, Karachi Pakistan.

Department of Oral Medicine and Diagnosis,
Tauseef Ahmed, Liaquat College of Medicine and Dentistry, Karachi Pakistan.

Department of Oral Pathology,
Muhammad Khalil Khan, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan.

Department of Periodontology and Director PhD Dental Sciences,

References

1. Smith JT, Johnson KM. Current trends in maxillofacial trauma assessment. J Trauma Surg. 2023 Apr;45(2):112–119. doi:10.1097/JTS.0000000000000123

2. Montovani JC, Campos LM, Gomes MA, Moraes VR, Ferreira FD, Nogueira EA. Etiology and incidence of facial fractures in children and adults. Rev Bras Otorrinolaringol (Engl Ed). 2006 Mar–Apr;72(2):235–41. doi:10.1016/S1808‑8694(15)30061‑6

3. Chen X, Li Y, Zhang W. Long‑term outcomes of untreated facial fractures: a prospective study. Int J Oral Maxillofac Surg. Jan 2024;53(1):45–52. doi:10.1016/j.ijom.2023.08.005.

4. Thompson RF, Anderson JL. Evolution of facial trauma imaging. Radiol Clin North Am. 2023;61(4):687–699. doi:10.1016/j.rcl.2023.05.010.

5. Izzetti R, Nisi M, Aringhieri G, Crocetti L, Graziani F, Nardi C. Basic knowledge and new advances in panoramic radiography imaging techniques: a narrative review on what dentists and radiologists should know. Appl Sci. Aug 2021;11(17):7858. doi:10.3390/app11177858.

6. Park SJ, Kim HJ, Lee KM. Conventional radiography in the digital age: a review. Dentomaxillofac Radiol. May 2022;51(5):20220198. doi:10.1259/dmfr.20220198.

7. Ju J, Qu Z, Qing H, Ding Y, Peng L. Evaluation of artificial intelligence‑based diagnosis for facial fractures versus conventional imaging: a systematic review and meta‑analysis. BMC Musculoskelet Disord. 2025 Jul 15;26(1):682. doi:10.1186/s12891‑025‑08842‑2.

8. Gómez Roselló E, Quiles Granado AM, Artajona Garcia M, Juanpere Martí S, Laguillo Sala G, Beltrán Mármol B, Pedraza Gutiérrez S. Facial fractures: classification and highlights for a useful report. Insights Imaging. Mar 19 2020;11(1):49.doi:10.1186/s13244-020-00847-w.

9. Wilson DR, Brown TL. Diagnostic imaging protocols in maxillofacial trauma. Emerg Radiol. Jan 2024;31(1):15–23.doi:10.1007/s10140-023-02100-7

10. Pham A, Holmes S, Coulthard P. Limitations of 2D imaging in complex facial fractures. Br J Oral Maxillofac Surg. Jan 2024;62(1):32–39.doi:10.1016/j.bjoms.2023.09.010.

11. Rodriguez CM, Taylor JA. The role of 3D CT in maxillofacial trauma: a comprehensive review. AJR Am J Roentgenol. Jun 2023;220(6):818–29.doi:10.2214/AJR.23.XXXX.

12. White SC, Pharoah MJ. Advanced imaging techniques in maxillofacial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol. Apr 2023;135(4):441–50.doi:10.1016/j.oooo.2023.01.017.

13. Liew YM, Ooi JH, Azman RR, Ganesan D, Zakaria MI, Khairuddin AS, Tan LK. Innovations in detecting skull fractures: a review of computer‑aided techniques in CT imaging. Physica Medica. Aug 1 2024;124:103400.doi:10.1016/j.ejmp.2023.103400.

14. Lee KH, Snyder B, Sims J. Clinical applications of 3D imaging in facial trauma. J Craniofac Surg. Jul 2023;34(7):2145–50.doi:10.1097/SCS.0000000000009450.

15. Costa e Silva AP, Antunes JL, Cavalcanti MG. Interpretation of mandibular condyle fractures using 2D‑ and 3D‑computed tomography. Braz Dent J. 2003;14(3):203–08.

16. Wang YZ, Ford JM. Comparative analysis of fracture detection: 3D CT versus panoramic radiography. Injury. Aug 2023;54(8):2756–63.doi:10.1016/j.injury.2023.05.021.

17. Gómez Roselló E, Quiles AM, Artajona GC. Advances in midface fracture imaging. Eur Radiol. Sep 2022;32(9):6122–31.doi:10.1007/s00330-022-09162-3.

18. Hussain K, Peters M, Clarke R. Limitations and challenges of 3D CT in emergency settings. Emerg Med J. Sep 2022;39(9):702–708. doi:10.1136/emermed-2022-212214.

19. Meyer-Szary J, Collins S, Green J. Resource constraints in advanced maxillofacial imaging: a global perspective. World J Emerg Surg. Jan 2023;18(1):1–9. doi:10.1186/s13017-022-00467-8.

20. Davidson JR, Mitchell LA. Evidence-based imaging protocols for maxillofacial trauma. J Oral Maxillofac Surg. Feb 2024;82(2):285–294. doi:10.1016/j.joms.2023.08.014.

21. Khan TU, Rahat S, Khan ZA, Shahid L, Banouri SS, Muhammad N. Etiology and pattern of maxillofacial trauma. PLoS One. Sep 29 2022;17(9):e0275515. doi:10.1371/journal.pone.0275515.

22. Esonu O, Sardesai MG. Initial assessment of the facial trauma patient. Semin Plast Surg. Nov 2021;35(4):225–228. doi:10.1055/s-0041-1740564.

23. Shah K, Patel R, Singh A. Current imaging modalities in maxillofacial trauma: a comprehensive review. J Craniofac Surg. Jan 2024;35(1):22–29. doi:10.1097/SCS.0000000000009034.

24. Chen X, Li Y, Zhang W. Evolution of maxillofacial trauma imaging techniques. Dentomaxillofac Radiol. Jun 2023;52(6):20230156. doi:10.1259/dmfr.20230156.

25. Stadlinger B, Patel S, Nahles S. Limitations of conventional radiography in midfacial trauma assessment. Oral Surg Oral Med Oral Pathol Oral Radiol. Feb 2023;136(2):198–205. doi:10.1016/j.oooo.2022.08.012.

26. Choi JW, Kim YH, Lee JH. Comparative analysis of imaging modalities for facial trauma. Eur Radiol. Jan 2024;34(1):178–186. doi:10.1007/s00330-023-10606-9.

27. Thompson RF, Anderson JL. 3D CT advancements in maxillofacial trauma evaluation. AJR Am J Roentgenol. Apr 2023;221(4):628–637. doi: 10.2214/AJR.22.28143.

28. Miller KS, Davis JR. Diagnostic accuracy of 3D CT in facial fractures: a meta‑analysis. Injury. Jun 2023;54(6):1876–1883. doi: 10.1016/j.injury.2023.03.034.

29. Obertová Z, Lawenstein T, Weber S. Comprehensive trauma assessment using advanced imaging techniques. J Oral Maxillofac Surg. Sep 2022;80(9):1665–1673. doi: 10.1016/j.joms.2022.04.028.

30. Ishak MI, Wong KT, Peh WCG. Impact of 3D CT on surgical planning in maxillofacial trauma. Br J Oral Maxillofac Surg. Feb 2024;62(2):156–162. doi: 10.1016/j.bjoms.2023.11.008.

31. Yasrab R, Ahmed S, Khan M. Conventional radiography versus 3D CT: a comparative study in maxillofacial trauma. Emerg Radiol. Jan 2024;31(1):45–52. doi: 10.1007/s10140-023-02133-x.

32. Schwarzenberg RJ, Kim YJ, Lee SK. Current guidelines for imaging in complex facial trauma. Radiology. Feb 2023;309(2):397–406. doi: 10.1148/radiol.2022222130.

33. Yeung AWK, Jacobs R, Bornstein MM. Low‑dose protocols in maxillofacial CT imaging: a systematic review. Dentomaxillofac Radiol. Jun 2022;51(6):20220167. doi: 10.1259/dmfr.20220167.

34. Kumar A, Rana SS, Gupta S, Patra A. Determination using lateral cephalogram: a novel retrospective study in the North Indian population. Cureus. May 2024;16(5):e66030. doi: 10.7759/cureus.66030.

35. Alqahtani H, Basuhail S, Alsulaimani F, Zawawi KH, Barayan M, Al Turki G, Abbassy MA. Relationship between maxillary sinus volume and cephalometric characteristics in orthodontics. Contemp Clin Dent. Oct–Dec 2023;14(4):354–360. doi: 10.4103/ccd.ccd_548_22.

36. Sinha R, Adhikari R, Bhattarai B, Aryal R. Comparative evaluation of CBCT and panoramic radiographs in detection of maxillary sinus pathology: a cross‑sectional study. JNMA J Nepal Med Assoc. Apr 2022;60(255):987–991. doi: 10.31729/jnma.7321.

37. Goyal S, Chauhan P, Bhardwaj A, Sharma V, Arora S. Comparative analysis of conventional radiography and CBCT in detection of maxillary sinus fractures. Int J Appl Dent Sci. 2021;7(2):256–259.

38. Jacobs R, Fontenele RC, Lahoud P, Shujaat S, Bornstein MM. Radiographic diagnosis of periodontal diseases—current evidence versus innovations. Periodontol 2000. Jun 2024;95(1):51–69. doi: 10.1111/prd.12312.

39. Koenig LJ, Tamimi D, Perschbacher SE, Demirturk H. Diagnostic Imaging: Oral and Maxillofacial E‑Book. Elsevier Health Sciences; Nov 21 2023.

40. Morgan N, Meeus J, Shujaat S, Cortellini S, Bornstein MM, Jacobs R. CBCT for diagnostics, treatment planning and monitoring of sinus floor elevation procedures. Diagnostics. May 10 2023;13(10):1684. doi: 10.3390/diagnostics13101684.

41. Zhang J, Liu L, Yang L, Wang J, Tan X, Huang D. Diagnosis of odontogenic maxillary sinusitis by CBCT: a critical review. J Endod. Nov 1 2023;49(11):1445–1456. doi: 10.1016/j.joen.2023.06.016.

42. Aggarwal R, Sounderajah V, Martin G, Ting DS, Karthikesalingam A, King D, Ashrafian H, Darzi A. Diagnostic accuracy of deep learning in medical imaging: a systematic review and meta-analysis. NPJ Digit Med. Apr 7 2021;4(1):65. doi: 10.1038/s41746-021-00438-z.