Radiology · patient case question
Which single projection best demonstrates a suspected MANDIBULAR fracture?
Patient case: Films for a Patient Not Seen in Ten Years
Patient: 48-year-old male
Chief Complaint: “I want a full check-up. I know it's been a while.”
Background: Last dental visit approximately ten years ago. No current symptoms. Reports his gums bleed when he brushes.
Medications: None
Vital Signs: BP 128/80 mmHg · HR 76 bpm · RR 16 · T 98.4°F
Findings: Generalized 5–7 mm pockets with bleeding on probing and visible recession. Several teeth are slightly mobile. On imaging: a horizontally impacted #17 whose crown abuts the distal root of #18, which shows a concave defect at the contact point; a well-defined mixed radiolucent-radiopaque lesion at the apices of the mandibular anteriors, which all test VITAL; and a radiopaque structure superimposed over the mandible on both the panoramic and lateral cephalometric films.
Show answer and explanation
Correct answer: A. Panoramic radiograph
- A. CORRECT. The PANORAMIC film is the single most useful projection for suspected mandibular fracture. It displays the entire mandible in one image — symphysis, body, angle, ramus, coronoid and condyle — and reveals the multiple fracture sites that are so characteristic: because the mandible is a ring, a fracture at one point is very frequently accompanied by a second fracture elsewhere, classically a parasymphyseal fracture with a contralateral subcondylar fracture.
- B. The submentovertex projection shows the skull base, the zygomatic arches and the medial-lateral position of the condyles — useful for zygomatic arch fractures, not for the mandible generally.
- C. A lateral skull film superimposes the two sides of the mandible on each other, obscuring exactly what you need to see.
- D. A periapical shows fine detail of a small region but cannot survey the whole mandible, and cannot show the condyles at all.
Note: In practice, CT is the definitive imaging for facial trauma. But when the question offers only plain projections, panoramic is the answer for the mandible. Always look for a SECOND fracture.