Correlation Between Ocular Motility and Evaluation of Computed Tomography in Orbital Blowout Fracture

Despite extensive debate and publications in the management of blowout fracture (BOF), there are still considerable differences in the surgeons’ management of BOF due to a lack of reliable evidence-based studies. This article aimed to evaluate which BOF patients require surgical treatment due to functional and/or cosmetic deformities; evaluate which computed tomography (CT) scan findings predict these problems; and provide an algorithm in the management of BOF. Seventy-nine patients with BOF were treated conservatively and followed up prospectively regarding functional and cosmetic deformities for at least 1 year. The patients’ CT scans were analyzed and several measurements were performed. Patients’ symptoms and the clinical findings were correlated to the CT scan measurements. We found visible deformity in 37% of the patients, but only 10% chose to proceed to surgery due to cosmetic deformities. In patients with inferior BOF and a herniation < 1.0 mL, a visible deformity was found when the ratio between fracture and the fractured orbital wall areas was ≥42%, or the total area of the fracture was ≥ 2.3 cm2. In patients with inferior BOF and a herniation ≥ 1.0 mL, a visible deformity was found when the distance from the inferior orbital rim to the posterior edge of the fracture was ≥ 3.0 cm. In patients with inferomedial fracture, a visible deformity was found when the herniation was ≥ 0.9 mL. Diplopia improved significantly and remained in only 3% of the patients in nonoperated group. Hypoesthesia of the infraorbital nerve improved significantly, but 23% of the nonoperated and 50% of the operated patients still experienced loss of sensation at final control. In this prospective study, we found that not only herniated orbital volume but also other CT scan findings in BOF were crucial to predict late visible deformities. Based on these findings, we propose an algorithm for the prediction of late visible deformity with 83% accuracy. There are indications that diplopia without ocular motility disorder is due to edema and we recommend observation as long as the diplopia improves gradually.

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Computed tomography in traumatic orbital emergencies: a pictorial essay—imaging findings, tips, and report flowchart

Insights into Imaging ◽

10.1186/s13244-021-01142-y ◽

2022 ◽

Vol 13 (1) ◽

Author(s):

Michaela Cellina ◽

Maurizio Cè ◽

Sara Marziali ◽

Giovanni Irmici ◽

Daniele Gibelli ◽

...

Keyword(s):

Computed Tomography ◽

Foreign Bodies ◽

Imaging Modality ◽

Standard Technique ◽

Trauma Patients ◽

Ocular Motility ◽

Detailed Evaluation ◽

Pictorial Essay ◽

Post Traumatic ◽

Diagnostic Flowchart

AbstractComputed tomography (CT) is considered the gold standard technique for the assessment of trauma patients with suspected involvement of the eye and orbit. These traumas can result in dramatic consequences to visual function, ocular motility, and aesthetics. CT is a quick and widely available imaging modality, which provides a detailed evaluation of the orbital bony and soft tissue structures, an accurate assessment of the globes, and is used to guide the patients’ treatment planning. For a timely and accurate diagnosis, radiologists should be aware of fracture patterns and possible associated complications, ocular detachments and hemorrhages, and different appearances of intraorbital foreign bodies. This educational review aims to describe all post-traumatic orbital abnormalities that can be identified on CT, providing a list of tips and a diagnostic flowchart to help radiologists deal with this complex condition.

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Computed Tomography Scanning in the Evaluation of Ocular Motility Disorders

Diagnostic Imaging in Ophthalmology ◽

10.1007/978-1-4613-8575-2_3 ◽

1986 ◽

pp. 39-54

Author(s):

Mahmood F. Mafee ◽

Marilyn T. Miller

Keyword(s):

Computed Tomography ◽

Ocular Motility ◽

Motility Disorders ◽

Computed Tomography Scanning ◽

Tomography Scanning ◽

Ocular Motility Disorders

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The Utility of Postoperative Computed Tomography Imaging Following Isolated Orbital Blowout Fracture Repair

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520922048 ◽

2020 ◽

Vol 13 (3) ◽

pp. 198-204

Author(s):

Sara E. Francomacaro ◽

Jana A. Bregman ◽

Kalpesh T. Vakharia ◽

Francis L. Grumbine

Keyword(s):

Computed Tomography ◽

Medical Records ◽

Fracture Repair ◽

Imaging Findings ◽

Inclusion Criteria ◽

Computed Tomography Imaging ◽

Postoperative Imaging ◽

Reduce Radiation Exposure ◽

Blowout Fracture ◽

Care Costs

Purpose: To determine the clinical utility of computed tomography (CT) imaging following isolated orbital blowout fracture (OBF) repair. Methods: Single-center retrospective review of adult patients undergoing surgical repair of isolated OBFs between November 2008 and August 2016 who received postoperative CT scans. Preoperative and postoperative examination data, postoperative imaging reads, postoperative courses, and any reoperation documentation were collected from electronic medical records. Postoperative imaging findings were categorized as major, indeterminate, or minor by predicted impact on clinical management. Major findings indicated a need for reoperation, indeterminate a potential reoperation, and minor no reoperation. Results: Fifty-two cases met inclusion criteria: 94.2% (n = 49) of postoperative scans included minor findings, 34.6% (n = 18) indeterminate findings, and 19.2% (n = 10) major findings. Three patients returned to the operating room (OR) for surgical revision. All 3 had a significant and concerning change on postoperative examination. Only 1 also had a major finding on postoperative imaging. The remaining 49 patients had benign postoperative examinations, despite 9 (17.3%) with major imaging findings who did not undergo reoperation. Conclusions: In the majority of OBF repairs, postoperative CT scan findings were not predictive of a need to return to the OR for revision. Reoperation was instead largely prompted by concerning changes in the postoperative clinical examination. Our findings suggest that postoperative imaging in the absence of clinical concern should not be included in the surgical management of isolated OBFs. Instead, targeted imaging will help reduce radiation exposure and health-care costs without sacrificing patient care.

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Utility of Ocular Motility Tests in Orbital Floor Fractures with Muscle Entrapment That is Not Detected on Computed Tomography

Clinical Ophthalmology ◽

10.2147/opth.s292097 ◽

2021 ◽

Vol Volume 15 ◽

pp. 1677-1683

Author(s):

Raffaele Migliorini ◽

Anna Maria Comberiati ◽

Fernanda Pacella ◽

Anna Rosy Longo ◽

Daniela Messineo ◽

...

Keyword(s):

Computed Tomography ◽

Orbital Floor ◽

Ocular Motility ◽

Orbital Floor Fractures

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Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0038-1641170 ◽

2018 ◽

Vol 11 (3) ◽

pp. 165-171 ◽

Cited By ~ 3

Author(s):

Babak Alinasab ◽

Karl-Johan Borstedt ◽

Rebecka Rudström ◽

Michael Ryott ◽

Abdul Rashid Qureshi ◽

...

Keyword(s):

Surgical Treatment ◽

Pilot Study ◽

Infraorbital Nerve ◽

Ocular Motility ◽

Posterior Edge ◽

Blowout Fracture ◽

Randomized Controlled ◽

Observational Group ◽

Orbital Rim ◽

Surgical Group

To clarify the conflicting recommendations for care of blowout fracture (BOF), a prospective randomized study is required. Here, we present a prospective randomized pilot study on BOF. This article aimed to evaluate which computed tomography (CT) findings predict late functional and/or cosmetic symptoms in BOF patients with ≥ 1.0 mL herniation of orbital content into maxillary and/or ethmoidal sinuses. It also aimed to evaluate which patients with BOF would benefit from surgical treatment or observational follow-up. Twenty-six patients with BOF ≥ 1.0 mL herniation were randomized to observational ( n = 10) or surgical treatments ( n = 16) and were followed up for functional and cosmetic symptoms for at least 1 year. The results from CT scan measurements were correlated to the patients’ symptoms and clinical findings which we report in this pilot study. Of the 10 patients randomized to observation, five had an inferomedial BOF with a herniation of ≥ 1.3 mL and all patients developed cosmetic deformities and required surgery. The remaining five patients in the observational group had inferior BOF and one of them had a distance of 3.3 cm from the inferior orbital rim to the posterior edge of the fracture and developed a cosmetic deformity but was unwilling to proceed to surgical treatment, and four patients had a median distance of 2.9 cm from the inferior orbital rim to the posterior edge of the fracture and did not develop cosmetic deformities. The median time from injury to surgery was 13 (3–17) days for the surgical group and 37 (17–170) days for the patients who underwent surgery in the observational group. The surgical results were similar for all the operated patients at the final control. Diplopia decreased and remained partly in one patient in the surgical group and in two patients in the observational group. Hypoesthesia of the infraorbital nerve decreased in nonsurgically treated patients, but surgery seemed to induce hypoesthesia. In this prospective randomized controlled pilot study on BOF, all patients in the observational group with inferomedial fractures developed visible deformity. Diplopia in BOF, without ocular motility limitation, is believed to be due to edema. Diplopia is not an indication for surgery as long as it reduces over time.

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Intraoperative Computed Tomography Image Fusion for Orbital Blowout Fracture Reconstruction

Archives of Orofacial Sciences ◽

10.21315/aos2021.16.1.1 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1-12

Author(s):

Abd Jabar Nazimi ◽

Syed Nabil

Keyword(s):

Computed Tomography ◽

Decision Making ◽

Image Fusion ◽

Ct Images ◽

Head Orientation ◽

Implant Position ◽

Orbital Implant ◽

Intraoperative Computed Tomography ◽

Implant Malposition ◽

Blowout Fracture

Intraoperative computed tomography (CT) has been previously described and acknowledged for its use in orbital blowout fracture reconstructions. We described a clinical case series managed by this technique combined with intraoperative image fusion for accuracy in orbital implant position. In total, eight patients who sustained a total number of 19 orbital wall fractures were described. From the total number of 19 blowout orbital fracture reconstructions comprised of medial and inferior (floor) orbital fractures, malposition was identified in a total of four orbital implants by using image fusion. All cases of implant malposition were immediately revised intraoperatively. Subsequent fusion was carried out to confirm whether the revision was satisfactorily achieved. We found that the intraoperative image fusion technique utilised to determine orbital implant position, especially at the posterior ledge, further augmented the role of intraoperative CT scanning. Image fusion conceptually provides an immediate, real-time, and objective solution for intraoperative image analysis and potentially eliminates problems with misaligned CT images. It also reduces the need for the surgeon to ‘eye-ball’ the CT images acquired or the need for additional intraoperative time, since the patient’s head orientation is always axially at random during the acquisition of the CT. Conventional methods for CT image assessment are subjected to one’s own interpretation and may introduce inconsistent or longer intraoperative decision-making. The technique facilitates intraoperative decision-making and reduces the risk of orbital implant malposition in orbital blowout fracture reconstructions. Hence, surgical complication in relation to orbital implant malposition in orbital blowout fracture management could be minimised. In addition, no further postoperative imaging is required.

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Periorbital Entrapment in a Minimally Displaced Medial Wall Fracture

Plastic Surgery Case Studies ◽

10.1177/2513826x20964071 ◽

2020 ◽

Vol 6 ◽

pp. 2513826X2096407

Author(s):

Kun Hwang

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Ct Scan ◽

Medial Wall ◽

Ocular Motility ◽

Orbital Fat ◽

Orbital Wall ◽

Medial Orbital Wall

I experienced periorbital entrapment in a minimally displaced medial wall fracture. An 18-year male was hit in the left eye by a fist. He had decreased horizontal ocular motility with pain. Exophthalmometry of both eyes were same. Computed tomography (CT) demonstrated a minimally displaced medial wall fracture with herniation of orbital fat. Decreased horizontal ocular motility and pain persisted until the fifth post-trauma day. On exploration, entrapped soft tissue was found and dissected from the fractured site, but the bony displacement was minimal. After release, the forced duction test became normal and postoperative CT demonstrated reduced herniated orbital fat. In cases of a minimally displaced medial orbital wall fracture, if the patient feels pain while gazing horizontally, precise inspection of the CT scan is needed. If the pain persists for several days, despite the absence of diplopia, periorbital entrapment should be suspected and exploration can be considered.

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