Rate of Agreement of Panoramic and Water's View in Diagnosis of Zygomatic Complex and Inferior Orbital Rim Fractures

Statement of problem: Evaluation of facial skeletal trauma is based on clinical and radiographic examinations. For many years, conventional radiographs have been used in diagnosis of fractures. Today, advanced techniques such as CT and 3D-CT gradually are used as complementary techniques for conventional methods. Panoramic radiography is one of these conventional radiographs which cover maxilla, mandible, zygoma and sometimes inferior orbital rims. “Water’s views” is the specialized radiographic technique of zygomatic bone and orbital rims in diagnosis of facial fracture. To determine the agreement of panoramic radiographs with water’s views in detection of zygomatic complex and inferior orbital rim fractures In this descriptive-analytical study, 58 panoramics and water’s views of patients with maxillofacial trauma were selected. These radiographs were coded and an experienced maxillofacial radiologist expressed about the presence or absence of fracture in maxillary process of zygomatic bone, inferior orbital rims, temporal process of zygoma, lateral wall of maxillary sinuses and zygomatic arch.The patients’ demographic information was gathered by SPSS version 11.5. Kappa analysis test was used for calculation of the agreement rate between two radiographs Pvalues < 0/05 was regarded as significant. Water’s and panoramic views had the most agreement rate of very good to ideal level in diagnosis of fracture of maxillary process of zygoma (p<0.001, K=0.76). The agreement rate in diagnosis of fracture of temporal process of zygoma, inferior orbital rim and lateral wall of maxillary sinuses was in medium to good level but the agreement rate in diagnosis of zygomatic arch fracture was the least. According to the results of this study, the panoramic findings must be taken seriously in diagnosis of the fracture of maxillary process of zygoma and inferior orbital rim. The importance of this view must be considered in diagnosis of mid facial fracture especially in traumatic patients due to widespread coverage of facial bones.