Tomography
Effect of Simulated Soft-Tissue Edema on Ultrasonographic Detection of Nondisplaced Dentoalveolar Fractures: An Ex Vivo Animal Model Study
By Sedef Ayşe Taşyapan, Murat Mert ATAPEK and Elif Yıldızer.
Abstract
Objectives
This single-blinded ex vivo diagnostic accuracy study evaluated high-frequency ultrasonography for detecting nondisplaced dentoalveolar fractures and assessed the effect of simulated post-traumatic soft-tissue edema.
Methods
Eighteen fresh sheep heads provided 108 anatomically distinct sites (54 fractured and 54 non-fractured controls). Two blinded oral and maxillofacial radiologists independently assessed each site, yielding 216 observer-level evaluations. Cone-beam tomography (CBCT) served as the reference standard. Edema was simulated by submucosal injection of 0.5, 1.0, or 1.5 mL sterile saline.
Results
Simulated edema was associated with significantly lower odds of correct ultrasonographic classification in the GEE analysis accounting for within-site clustering (OR = 0.217; 95% CI, 0.096–0.491; p < 0.001). Accuracy decreased from 87.0% to 59.3%, sensitivity from 96.3% to 77.8%, and specificity from 77.8% to 40.7%. False-negative and false-positive rates increased from 3.7% to 22.2% and from 22.2% to 59.3%, respectively. Observer confidence also decreased significantly (3.53 ± 0.90 vs. 2.61 ± 0.86; p < 0.001). No statistically significant differences in diagnostic accuracy were detected among the three edema-volume groups.