Evaluation of a computed-tomography-based assessment scheme in treatment decision-making for isolated orbital floor fractures

Treatment decisions for fractures of the orbital floor are based on clinical appearance, ophthalmological examination, and computed tomography (CT) scans. In extensive fractures, decisions are easily made between conservative and surgical treatment. However, objective parameters are rare in inconclu...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2018-09, Vol.46 (9), p.1550-1554
Main Authors: Frohwitter, Gesche, Wimmer, Stephan, Goetz, Carolin, Weitz, Jochen, Ulbig, Michael, Kortuem, Karsten U., Dangelmaier, Julia, Ritschl, Lucas, Doll, Christian, Ristow, Oliver, Kesting, Marco R., Koerdt, Steffen
Format: Article
Language:English
Subjects:
Computed tomography
Decision Making
Dentistry
Diplopia
Diplopia - etiology
Female
Germany
Humans
Male
Midface fracture
Oculomotor Muscles - diagnostic imaging
Oculomotor Muscles - injuries
Orbital floor
Orbital Fractures - complications
Orbital Fractures - diagnostic imaging
Orbital Fractures - surgery
Retrospective Studies
Tomography, X-Ray Computed
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Summary:Treatment decisions for fractures of the orbital floor are based on clinical appearance, ophthalmological examination, and computed tomography (CT) scans. In extensive fractures, decisions are easily made between conservative and surgical treatment. However, objective parameters are rare in inconclusive cases. Our retrospective study included 106 patients with unilateral isolated orbital floor fractures. Correlations between preoperative ophthalmological examinations and specific CT parameters were performed. The defect size of the fracture appeared to be significantly associated with the presence of diplopia. CT-morphological parameters and preoperative ophthalmological results showed statistical significance for diplopia and incarceration of inferior rectus muscle (IRM), diplopia and displacement of IRM, decreased mobility and incarceration of IRM, and decreased mobility and displacement of IRM. Our clinical assessment scheme for CT scans of orbital floor fractures is aimed at facilitating treatment decision making using four CT-based variables. As critical size defects of the orbital floor of ≥2 cm2 are likely to cause clinically significant posterior displacement of the globe, resulting in enophthalmos, the proposed parameters offer a readily accessible and easy to evaluate scheme that helps to identify patients in need of surgical intervention.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2018.06.016