Orbital trauma: from anatomy to imaging patterns

• Published in: Romanian neurosurgery Vol. 18; no. 4
• Main Authors: B. Dobrovăţ, R. Popescu, A. Nemtoi, O. Ladunca, D. Haba
• Format: Journal Article
• Language: English
• Published: London Academic Publishing 01.12.2011
• Subjects: computer tomography; fracture; multiplanar reconstruction (MPR); orbital trauma
• ISSN: 1220-8841; 2344-4959

Objective: In assessing the patients with orbital trauma, a basic knowledge of anatomy of this region is necessary to determine the gravity and the extent of traumatic injury. Since the development of high resolution CT, significant progress has been made for the evaluation of orbital trauma, adding more sensitivity to the plain x-ray method. Other imaging methods that can be useful is ultrasonography and MRI. The objective of this article is to review the orbital anatomy correlated with the common CT imaging patterns, and to establish the modality of choice in assessing orbital trauma.  Methods: We retrospectively analyzed 297 patients with facial trauma who were submitted to spiral CT scanning. The CT images were interpreted using the following protocols: axial, multiplanar reconstruction (MPR), 3D images and association of axial/MPR/3D images. We evaluated the anatomical sites of lesions, dividing them according to the orbital walls: lateral; medial; superior (roof) and inferior (anterior, medial).  Results: In our study 35% of patients who suffered facial trauma had ocular or orbital injuries. Most frequent site of orbital fractures was the medial wall. Association of axial/MPR images interpretation increase the sensitivity of CT diagnosis compared with only axial protocol.  Conclusions: Facial traumatized patients with clinical suspicion of orbital injuries are usually first evaluated with spiral CT, the best protocol is to obtain thin-section (1-3 mm) axial CT scans and then performing multiplanar reformation (specially coronal reformation is very useful). Knowledge of diverse imaging patterns of potential injuries is essential to make a fast and accurate diagnosis of post-traumatic orbital injury.