A Comparative Study on the Diagnostic Utility of Ultrasonography and Conventional Radiography With Computed Tomography as the Gold Standard in the Detection of Facial Trauma Fractures

Introduction: Facial fractures require accurate and timely diagnosis, while conventional radiography may be limited by anatomical superimposition.Computed tomography (CT) provides detailed assessment but involves ionizing radiation and may have limited availability.Ultrasonography (USG) offers a radiation-free, portable alternative for selected facial fractures.This study compared the diagnostic performance of USG and conventional radiography using CT as the reference standard.Materials and methods: This prospective comparative study was conducted in the Department of Radiodiagnosis, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, among 53 patients with suspected facial trauma fractures.All participants underwent USG, conventional radiography, and CT.Fractures involving the nasal bone, zygomatic arch, maxillary sinus, symphysis/parasymphysis, and frontal sinus were evaluated.Each participant contributed five predefined anatomical-site observations, resulting in 265 site-level observations.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated using CT as the reference standard.Results: CT identified 72 fracture-positive anatomical-site observations across the evaluated anatomical sites.USG detected 63 (87.50%) fractures, while conventional radiography detected 51 (70.83%).USG demonstrated sensitivity of 87.50%, specificity of 98.45%, PPV of 95.45%, NPV of 95.48%, and overall accuracy of 95.47%.Conventional radiography demonstrated sensitivity of 70.83%, specificity of 97.93%, PPV of 92.73%, NPV of 90.00%, and accuracy of 90.57%.USG demonstrated numerically higher sensitivity and overall diagnostic accuracy than conventional radiography across the evaluated anatomical sites.Conclusion: USG demonstrated good diagnostic performance for selected facial fractures and numerically higher sensitivity and overall diagnostic accuracy than conventional radiography.It may serve as a useful radiation-free adjunctive modality for selected facial fractures, particularly when rapid or bedside assessment is desirable, while CT remains important for comprehensive assessment and confirmation of complex facial trauma.Further studies involving larger, multicentric populations and a broader range of facial fracture patterns are warranted to validate these findings and better define the role of USG in facial trauma imaging.