CT-Scan Images of The Posterior Orbital, Orbital Apex, Extraocular Muscles Positions and Axes in Craniosynostosis

Abstract

Craniosynostosis is the premature and pathological fusion, either partial or complete, of one or more cranial sutures. One of the ophthalmological complications is strabismus (in 39–76% of cases), with more severe manifestations in syndromic craniosynostosis. Head-CT with 3D-reconstruction can be used to evaluate the anatomical abnormalities of the orbital aspects to assist clinicians in planning surgery. Materials and Methods: A retrospective descriptive–observational study was conducted for 43 patients in the period from January 2017 to March 2022. The patients had syndromic or non-syndromic craniosynostosis and underwent head CT-scans at Dr. Soetomo General Hospital, Surabaya. The posterior orbital bones, orbital apexes, positions and axes of the extraocular muscles were evaluated by an neuroimaging radiology consultant. Results: 26 male subjects (60.5%) and 17 female subjects (39.5%) were evaluated. 18 patients (41.9%) had normal posterior orbital configurations and extraocular muscles, 4 (9.3%) showed mild abnormalities, 13 (30.2%) had moderate abnormalities, 2 (4.7%) showed moderate–severe abnormalities, and 6 (11.6%) had seesaw pattern abnormalities. 33 patients (76.7%) had normal orbital apex configurations, 3 (7%) showed ballooning ethmoidal sinuses, 2 (4.7%) had protrusions of the lateral orbital wall (greater sphenoid wing), and 5 (11.6%) showed combined ethmoidal sinus ballooning and protrusion of the lateral orbital wall. Conclusion: The smallest excyclorotation was observed for the mild abnormalities of the posterior orbital configuration and extraocular muscles in the right eye (4.5–11.3°) and left eye (3.6–7°). The greatest was noted for the seesaw pattern in the right eye (7.6–21.4°) and left eye (7.4–30°). 3 patients (7%) had an incyclorotated axis and 26 (60.5%) had an excyclorotated axis, with a greater degree of excyclorotation in the seesaw pattern.