The use of cone beam computed tomography in the management of isolated orbital floor fractures

doi:10.1016/j.bjoms.2008.05.005

British Journal of Oral and Maxillofacial Surgery

Volume 47, Issue 1, January 2009, Pages 65-66

https://doi.org/10.1016/j.bjoms.2008.05.005 Get rights and content

Abstract

Isolated fractures of the orbital floor are diagnosed by a combination of clinical and radiographic findings. Computed tomography is considered the imaging method of choice. We describe the use of cone beam computed tomography for use in isolated fractures of the orbital floor. This shows defects in the orbital floor but with a lower dose of radiation than conventional computed tomography.

Section snippets

Case 1

A 39 year old man attended the Accident and Emergency Department complaining of pain on the left side of his face and double vision after an alleged assault. His medical history was unremarkable. Examination showed left periorbital oedema, paraesthesia of V2, a subconjunctival haemorrhage with no posterior limit, and diplopia in upward gaze. Occipitomental radiographs showed no obvious signs of facial fractures. He was initially treated conservatively, but his diplopia did not resolve, an 8 cm

Discussion

Patients with isolated fractures of the orbital floor may present with enophthalmos, diplopia, and disturbed ocular movements. The fracture may cause herniation of fat into the maxillary sinus, which is thought to be responsible for the enophthlmos.¹ The inferior rectus and inferior oblique muscles may also be entrapped in the defect or become damaged by haemorrhage or oedema that restrict ocular movements.² Surgical intervention depends upon the degree of enophthalmos, ocular restriction, and

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Citation Excerpt :
CBCT has been used in those cases where conventional radiography has failed to provide sufficient diagnostic information, and can be used as an alternative to MDCT when soft-tissue detail is not required.42 Examples include condylar, zygomatic arch, and some zygomatic complex fractures (Fig 8a).83–85 For orbital floor fractures, where information on herniation of intra-orbital contents is required (e.g., the extraconal fat or inferior rectus muscle), MDCT would be the imaging technique of choice.
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
Cone beam computed tomography for imaging orbital trauma - Image quality and radiation dose compared with conventional multislice computed tomography
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The radiation dose from CBCT was significantly lower than the lowest dose from conventional CT in terms of effective dose and dose to the eye lens. A previous case report on CBCT in orbital trauma14 alluded to the possibility of lower radiation doses than conventional CT, and here we confirm and quantify it. The recommendation of the ICRP to reduce the threshold for cataracts has been adopted by the Health Protection Agency, the UK advisory body responsible for radiation protection.15
We compared the image quality and radiation dose to the lens of the eye in patients with suspected orbital fractures who were imaged using cone beam computed tomography (CBCT) or conventional multislice computed tomography (CT). Although CBCT has a lower radiation dose than conventional CT, it is not known whether the image quality is comparable for diagnostic purposes. We identified fractures of the orbit (floor or roof, or both) in 6/10 patients who were scanned using CBCT and in 5/10 patients who were scanned using multislice CT (orbital floor and medial wall). Impingement of the rectus muscle on fracture lines was identified with both techniques, but retro-orbital haemorrhage was detected only on multislice CT. The mean radiation dose to the lens of the eye was 42% lower (range 23–53, SD 10) for CBCT than for multislice CT (p < 0.001), and the effective dose (a measure of the risk of developing a radiation-induced cancer) was also significantly lower. CBCT can therefore be used to diagnose orbital fractures, and is associated with a significantly lower radiation dose than multislice CT.
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To evaluate cone beam computed tomography (CBCT) for monitoring of tibial bone defect healing in comparison to histopathological findings.
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The extent of osseous consolidation in CBCT volumetry ranged from 14% to 92% (mean, 63.4 ± 17.6%). There was a significant positive correlation between histologically visible newly formed bone and the extent of bone regeneration on CBCT volumetry (r = 0.74–0.79, P < .001). The visual score matched with the volumetric results in 75% of the cases.
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Whilst fortunately rare (particularly in the UK), explosions to the lower face create a transverse fracture of the mandible which usually occurs below the mylohyoid line with decoronation of teeth at the level of the amelo-cemental junction.22 There were 16 short communications23–38 and 8 letters to the editor39–45 published in 2008–9 relating to facial trauma. In a recent review of short communications published in BJOMS in 2008–9, and using established criteria for assessment, it was found that nearly 48% of all published short communications published during that period (142 papers) did not add much new information to existing knowledge.6
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Short communicationThe use of cone beam computed tomography in the management of isolated orbital floor fractures

Abstract

Section snippets

Case 1

Discussion

J Emerg Med

Eur J Radiol

Prediction of late enophthalmos by volumetric analysis of orbital fractures

Ophthal Plast Reconstr Surg

Clinical recommendations for repair of orbital facial fractures

Curr Opin Ophthalmol

Isolated orbital blowout fractures: survey and review

Br J Oral Maxillofac Surg

Short communication
The use of cone beam computed tomography in the management of isolated orbital floor fractures