J Korean Assoc Oral Maxillofac Surg 2018; 44(1): 18~24
Comparison of accuracy between panoramic radiography, cone-beam computed tomography, and ultrasonography in detection of foreign bodies in the maxillofacial region: an in vitro study
Mehrdad Abdinian1,2, Maedeh Aminian2, Samad Seyyedkhamesi3
1Dental Implants Research Center and 2Department of Radiology, School of Dentistry, Isfahan University of Medical Science,
3Department of Oral and Maxillo-Facial Surgery, School of Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
Maedeh Aminian
Department of Radiology, School of Dentistry, Isfahan University of Medical Science, P.O. Box 319, Hezar-Jerib Ave., Isfahan 81746-73461, Iran
TEL: +98-3136680048 FAX: +98-3136699357
E-mail: maedeh_aminian@yahoo.com
ORCID: http://orcid.org/0000-0003-1087-5209
Received July 15, 2017; Revised August 16, 2017; Accepted August 16, 2017.; Published online February 28, 2018.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives: 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.
Materials and Methods: 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 (P<0.05).
Results: CBCT was more accurate in detection of FBs than panoramic radiography and US (P<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 (P<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.
Conclusion: 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.
Keywords: Foreign bodies, Panoramic radiography, Cone-beam computed tomography, Ultrasonography, Maxillofacial region
Fig. 1. Visibility scores of foreign bodies embedded on the ST, BS, and A using panoramic radiography, CBCT and US

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