Satnam Kaur, Chandni Shah, Shilen Patel, Micheal Perry


Mandibular fractures are a type of oral maxillofacial trauma that usually requires urgent surgical or non-surgical intervention. OPGs play a critical role in investigating and ultimately diagnosing patients with suspected mandibular fractures. Failure to take a satisfactory OPG for trauma patients could lead to a missed diagnosis and ultimately have a detrimental effect on the patient’s ability to function and thus may be seen as a form of negligence.

  • Assess and grade orthopantomogram (OPG) x-rays taken for maxillo-facial trauma following current guidelines
  • To determine what proportion of these x-rays are undiagnostic
  • To examine repeat images
  • To discuss why some OPG x-rays may not include the entire mandible and whether this has any impact upon treatment.

372 pre-operative OPG x-rays taken in the A&E department at NWP for maxillo-facial trauma over a 1-year period from July 2016 to June 2017 were randomly selected for grading. The images were graded from 1 to 3 according to the quality assurance criteria outlined by FGDP and NRPB guidelines. The guidelines set a standard that no less than 75% of dental radiographs should be a grade 1.


From the 372 OPGs, 197 (53%) were grade one, 122 (33%) were grade 2 and 53 (14%) were given a grade 3. From the 53 cases of grade 3 OPGs, 41 (77%) of these were due the entire mandible not being captured on the radiograph. 32 (60%) of grade 3 OPGs were repeated.


The standard set was not met. There are many factors which can impact on the quality of an OPG which can include both patient and operator errors. It is important that we eliminate operator error and any subsequent radiation


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