The use of reformatted Cone Beam CT images in assessing mid-face trauma, with a focus on the orbital floor fractures

Abstract

Background and aimThis study aims at evaluating the reliability on specific multi-planar cone beam computer tomography (CBCT) reconstruction in the orbital floor fractures.MethodsCBCT examination of the mid-face fractures area involving the floor of the orbit was performed in a number of 93 trauma patients by two independent radiologists. Both radiologists assessed the axial, coronal and sagittal sections and also the oblique coronal and sagittal extracted sections evaluating the location of the orbital fractures, its size and displacement, the involvement of the infra-orbital foramen, herniation of fat or muscle within the maxillary sinus, the overall type of the fracture and the implication of lateral or medial orbital wall. We also registered the section that provided better confidence of both examiners in visualizing the fracture of the orbit floor and the presence of herniated soft tissue, on different reformatted sectioning.ResultsThe presence of pure fracture of the orbital floor was detected in 11% of patients. The association of the orbital fractures with the zygomatic fractures was identified in the majority of the patients. In 86% of patients the displacement of the floor of the orbit was visualized, and in almost 30% of cases more than 50% of the orbital floor was involved in the fracture. Regarding the confidence between examiners, they were more confident using the oblique sagittal CBCT reformatted images for fracture detection and bone displacement evaluation, as for the soft tissue herniation the oblique coronal sections provided the highest level of confidence.ConclusionMid-face trauma involves the orbital floor in the majority of situations. CBCT allows to obtain oblique images extracted from the three dimensional (3D) data that provide high confidence level in assessing pure orbital floor fractures.

Validity of computed tomography in diagnosing midfacial fractures

“…The use of cone beam computer tomography (CBCT) is quite popular in many dental clinics and some hospitals nowadays. They are more cost-effective, have a very good diagnostic value, and allow reconstruction of oblique images extracted from the 3D data, which is useful when assessing pure orbital floor fractures 28 . However, the main disadvantage of CBCT for midfacial fractures is that the patient needs to stand upright, which might be a problem for patients with severe head injuries, with cervical fractures or unconscious/sedated, and therefore they are not used routinely in most hospitals.…”

Ergebnisse und Lebensqualität nach individueller computer-gestützter Rekonstruktion des Mittelgesichtes

“…In particular spiral CT technology (CT) and cone beam tomography (CBCT) must be mentioned in the context of midfacial trauma. Modern CBCT is often superior to CT scan with regard to diagnostics for hard tissue because metallic artifacts are less negatively overlying compared to CT diagnostics [14,15]. If soft tissue has to be evaluated like for example with regard to intraorbital bleeding, contrast-enhanced CT scan must certainly be preferred [16,17].…”

“…Moderne DVT ist z.T. dem CT im Hinblick auf die Diagnostik für das Hartgewebe überlegen, da metallische Artefakte weniger negativ überlagernd sind als in der CT-Diagnostik [14,15]. Sind Fragen des Weichgewebes adressiert, wie z.…”

Diagnosis and Treatment of Midface Trauma in the Context of Polytrauma: Characteristics during COVID-19 Pandemic Conditions

“…Head CT scan in axial and coronal sections is compulsory, but frequently sagittal section reconstructions offer useful data about the anterior segment of the skull base and orbital floor. 3D reconstructions are useful for surgical planning and even explaining the patient the complexity of the trauma and improve informed consent (Figure 1) [9].…”