Clinical Oral Investigations

, Volume 7, Issue 4, pp 226–229 | Cite as

Potentials of ultrasound in the diagnosis of midfacial fractures*

  • R. E. Friedrich
  • M. Heiland
  • S. Bartel-Friedrich
Original Article


The aim of this study was to evaluate the application and limitation of ultrasound in the diagnosis of midfacial fractures. Eighty-one patients with radiologically proved fractures of the facial skeleton were included in this study. Examinations were performed using a 7.5-MHz small-part applicator. Another ten patients without facial fractures served as controls with normal sonoanatomical findings. The most important deficiency of ultrasound in the diagnosis of midfacial fractures is the difficult detection of non-dislocated fractures. According to our own experiences, the application of ultrasound in midfacial fractures is most useful for visualization of the zygomatic arch and the anterior wall of the frontal sinus, with immediate imaging after closed reduction avoiding radiation exposure. Moreover, it is restricted to fractures of the orbital margin and nasal bone. If ultrasound is performed as the first imaging modality in cases of suspected facial fractures by an experienced investigator, the visualization of fracture lines can avoid conventional imaging, so that only an indicated CT scan can be added. In doubtful cases, an individual combination of conventional radiographs would be the next step. By this, an overall reduction of radiation exposure seems possible.


Ultrasound B-scan ultrasonography Midfacial imaging 


  1. 1.
    Akizuki H, Yoshida H, Michi K (1990) Ultrasonographic evaluation during reduction of zygomatic arch fractures. J Cranio Maxillofac Surg 18:263–266Google Scholar
  2. 2.
    Bleier R, Rochels R (1986) Echographische Diagnostik bei Nasennebenhöhlenverletzungen. Laryngo Rhino Otol 65:423–426Google Scholar
  3. 3.
    De Viesscher JGAM, van der Waal KGH (1988) Medial orbital wall with enophthalmos. J Cranio Maxillofac Surg 16:55–59Google Scholar
  4. 4.
    Forrest CR, Lata AC, Marcuzzi DW, Bailey MH (1993) The role of orbital ultrasound in the diagnosis of orbital fractures. Plast Reconstr Surg 92:28–34PubMedGoogle Scholar
  5. 5.
    Friedrich RE, Volkenstein RJ (1991) Wertigkeit der Sonographie für die Diagnose von Jochbogenfrakturen. Dtsch Z Mund Kiefer GesichtsChir 15:472–479PubMedGoogle Scholar
  6. 6.
    Friedrich RE, Plambeck K, Bartel-Friedrich S, Giese M, Schmelzle R (2001) Limitations of B-scan ultrasound for diagnosing fractures of the mandibular condyle and ramus. Clin Oral Invest 5:11–16Google Scholar
  7. 7.
    Geyer G, Rochels R (1984) Endoskopische und sonographische Diagnostik bei Orbitabodenfrakturen. Fortschr Ophthalmol 81:119–121PubMedGoogle Scholar
  8. 8.
    Guthoff R (1988) Ultraschall in der ophthalmologischen Diagnostik. Enke Verlag, StuttgartGoogle Scholar
  9. 9.
    Hammerschlag SB, Hughes S, O’Reilly GV, Naheedy MH, Rumbaugh CL (1982) Blow-out fractures of the orbit: a comparison of computed tomography and conventional radiography with anatomical correlation. Radiology 143:487–492PubMedGoogle Scholar
  10. 10.
    Hassfeld S, Streib S, Sahl H, Stratmann U, Fehrentz D, Zöller J (1998) Low-dose-Computertomographie des Kieferknochens in der präimplantologischen Diagnostik. Mund Kiefer GesichtsChir 2:188–193PubMedGoogle Scholar
  11. 11.
    Heiland M, Schulze D, Adam G, Schmelzle R (2003) 3D-imaging of the facial skeleton with an isocentric mobile C-arm system (Siremobil Iso-C3D). Dentomaxillofac Radiol 32:21–25CrossRefPubMedGoogle Scholar
  12. 12.
    Hell B (1990) Atlas der Ultraschalldiagnostik im Kopf-Hals-Bereich. Thieme Verlag, StuttgartGoogle Scholar
  13. 13.
    Irnberger T (1985) Diagnostische Möglichkeiten und Wertigkeit der konventionellen Radiographie, Röntgentomographie und hochauflösenden Computertomographie beim komplexen orbitalen Trauma. Fortschr Röntgenstr 142:146–154Google Scholar
  14. 14.
    Manson PN, Markowitz B, Mirvis S, Dunham M, Yaremchuk M (1990) Toward CT-based facial fracture treatment. Plast Reconstr Surg 85:202–212PubMedGoogle Scholar
  15. 15.
    McCann PJ, Brocklebank LM, Ayoub AF (2000) Assessment of zygomatico-orbital complex fractures using ultrasonography. Br J Oral Maxillofac Surg 38:525–529CrossRefPubMedGoogle Scholar
  16. 16.
    Ord RA, Le May M, Duncan JG, Moos KF (1981) Computerized tomography and B-Scan ultrasonography in the diagnosis of fractures of the medial orbital wall. Plast Reconstr Surg 67:281–288PubMedGoogle Scholar
  17. 17.
    Piette E, Lenoir JL, Reychler H (1987) The diagnostic limitations of ultrasonography in maxillofacial surgery. J Cranio Maxillofac Surg 15:297–305Google Scholar
  18. 18.
    Rochels R (1987) Ultraschalldiagnostik bei Frakturen der knöchernen Orbita. In: Schwenzer N, Pfeifer G (eds) Fortschritte der Kiefer- und Gesichtschirurgie, Bd. 32. Thieme, Stuttgart, pp 144–147Google Scholar
  19. 19.
    Tonami H, Nauagawa T, Ohguchi M, Takarada A, Yamamoto JI, Karino K, Sasaki K (1987) Surface coil MR-imaging of orbital blowout fractures: a comparison with reformated CT. AJNR 8:445–449Google Scholar
  20. 20.
    Ziegler CM, Woertche R, Brief J, Hassfeld S (2002) Clinical indications for digital volume tomography in oral and maxillofacial surgery. Dentomaxillofac Radiol 31:126–130CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • R. E. Friedrich
    • 1
  • M. Heiland
    • 1
  • S. Bartel-Friedrich
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Hospital Hamburg-EppendorfHamburgGermany

Personalised recommendations