Abdinian Mehrdad, Aminian Maedeh, Seyyedkhamesi Samad
Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran.
Department of Radiology, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran.
J Korean Assoc Oral Maxillofac Surg. 2018 Feb;44(1):18-24. doi: 10.5125/jkaoms.2018.44.1.18. Epub 2018 Feb 26.
Foreign bodies (FBs) account for 3.8% of all pathologies of the head and neck region, and approximately one third of them are missed on initial examination. Thus, FBs represent diagnostic challenges to maxillofacial surgeons, rendering it necessary to employ an appropriate imaging modality in suspected cases.
In this cross-sectional study, five different materials, including wood, metal, glass, tooth and stone, were prepared in three sizes (0.5, 1, and 2 mm) and placed in three locations (soft tissue, air-filled space and bone surface) within a sheep's head (one day after death) and scanned by panoramic radiography, cone-beam computed tomography (CBCT), and ultrasonography (US) devices. The images were reviewed, and accuracy of the detection modalities was recorded. The data were analyzed statistically using the Kruskal-Wallis, Mann-Whitney U-test, Friedman, Wilcoxon signed-rank and kappa tests (<0.05).
CBCT was more accurate in detection of FBs than panoramic radiography and US (<0.001). Metal was the most visible FB in all of modalities. US was the most accurate technique for detecting wooden materials, and CBCT was the best modality for detecting all other materials, regardless of size or location (<0.05). The detection accuracy of US was greater in soft tissue, while both CBCT and panoramic radiography had minimal accuracy in detection of FBs in soft tissue.
CBCT was the most accurate detection modality for all the sizes, locations and compositions of FBs, except for the wooden materials. Therefore, we recommend CBCT as the gold standard of imaging for detecting FBs in the maxillofacial region.
异物占头颈部所有病变的3.8%，其中约三分之一在初次检查时被漏诊。因此，异物给颌面外科医生带来了诊断挑战，在疑似病例中采用合适的成像方式很有必要。
在这项横断面研究中，制备了五种不同材料（包括木材、金属、玻璃、牙齿和石头），三种尺寸（0.5、1和2毫米），并放置在一只羊头部（死后一天）的三个位置（软组织、空气填充空间和骨表面），然后用全景X线摄影、锥形束计算机断层扫描（CBCT）和超声（US）设备进行扫描。对图像进行评估，并记录检测方式的准确性。使用Kruskal-Wallis检验、Mann-Whitney U检验、Friedman检验、Wilcoxon符号秩检验和kappa检验（<0.05）对数据进行统计学分析。
CBCT在检测异物方面比全景X线摄影和超声更准确（<0.001）。在所有检测方式中，金属是最易显影的异物。超声是检测木质材料最准确的技术，而CBCT是检测所有其他材料（无论尺寸或位置）的最佳方式（<0.05）。超声在软组织中的检测准确性更高，而CBCT和全景X线摄影在检测软组织中的异物时准确性最低。
除木质材料外，CBCT是检测各种尺寸、位置和成分异物最准确的检测方式。因此，我们建议将CBCT作为颌面区域异物检测的成像金标准。
