Abstract

Background: Le Fort II maxillary fracture is a complex “pyramidal” injury that may cause displacement, malocclusion, and facial deformity. Accurate and early diagnosis is essential for classification and surgical planning. Conventional radiographs and MDCT have limits in radiation dose and detecting fine fractures or associated injuries. Low-dose CBCT provides detailed 3D images, supporting comprehensive evaluation and precise fixation planning

Methods: A prospective descriptive study was conducted on 60 patients (Mar 2024 – Aug 2025) with suspected Le Fort II fractures. CBCT scans were performed using an HDX WILL cone-beam CT machine (field of view ~16×14.5 cm, voxel size 0.2 mm, 90 kVp, automatic mA, ~12 s scan time). Multiplanar reconstructions (axial, coronal, sagittal) and 3D surface renderings were obtained. Two physicians (an oral & maxillofacial surgeon and a radiologist) independently interpreted the CBCT images. The findings were compared with intraoperative or clinical consultation results as the gold standard. Sensitivity, specificity, accuracy, and Kappa coefficient were calculated for each fracture component (infraorbital rim, nasomaxillary buttress, zygomaticomaxillary buttress, pterygoid plate).

Results: CBCT demonstrated very high sensitivity (~94–97%) for Le Fort II fracture components, with specificity ~80–100% and accuracy ~92–97%. Inter-observer agreement was good to very good (Kappa 0.65–0.79). CBCT clearly revealed fracture lines and small bony fragments in the midface, contributing to changes in the surgical plan in approximately 40% of cases.

Conclusion: CBCT is a powerful diagnostic modality that provides detailed 3D visualization of facial bone fractures at a much lower radiation dose than conventional MDCT. Its application improves the detection of Le Fort II fractures and supports effective surgical planning, being especially useful in guiding fixation placement for these complex injuries.