Evaluation of Concomitant Orbital Floor Fractures in Patients with Head Trauma Using Conventional Head CT Scan: A Retrospective Study at a Level II Trauma Center.

Li-Kuo Huang,Ying-Yuan Chen,Chih-Yuan Fu,Hsi-Feng Tu,Liang-De Jiang

doi:10.3390/jcm8111852

Abstract

Background: Patients with head trauma may have concomitant orbital floor fractures (OFFs). The objective of our study was to determine the specific CT findings and investigate the diagnostic performance of head CT in detecting OFFs. Methods: We analyzed 3534 head trauma patients undergoing simultaneous head and facial CT over a 3-year period. The clinical data and specific head CT findings between patients with and without OFFs were compared. Results: In our cohort, 198 patients (5.6%) had OFFs visible on CT. On head CT, orbital floor discontinuity, gas bubbles entrapped between floor fragments, inferior extraconal emphysema, and maxillary hemosinus (MHS) were more commonly observed among patients with OFFs (p < 0.001). The absence of MHS had a high negative predictive value (99.7%) for excluding OFFs. Among the different types of MHS, the pattern showing high-attenuation opacity mixed with mottled gas had the highest positive predictive value (69.5%) for OFFs and was the only independent predictor of OFFs after adjusting for the other CT variables in all patients with MHS. Conclusion: Head CT may serve as a first-line screening tool to detect OFFs in head trauma patients. Hence, unnecessary facial CT and additional radiation exposure may be reduced.

Highlights

As maxillofacial fractures are frequently concomitant with head trauma because of the close anatomical proximity of the facial skeleton to the cranium [1,2], orbital fractures account for a significant portion of facial trauma [3,4,5]
For the incidence rate of 19.7% regarding concomitant orbital fractures associated with head trauma reported in one previous study [10], if there are no or only subtle fracture-related symptoms, and if clinically patients are unable to cooperate during the ophthalmologic examination, the orbital fractures may be left undetected without ordering additional facial computed tomography (CT) scans
The multivariate logistic regression analyses revealed that a younger age (odds ratio (OR), 0.98; 95% confidence interval (CI), 0.97–0.99; p < 0.001), being male (OR, 1.64; 95% CI, 1.14–2.37; p = 0.008), falling from an elevation of more than two meters (OR, 3.22; 95% CI, 1.38–7.54; p = 0.007), motorcycle collision (OR, 1.72; 95% CI, 1.17–2.52; p = 0.006), and positive physical findings with blepharohematoma (OR, 14.78; 95% CI, 9.94–21.98; p < 0.001), facial wounds (OR, 6.68; 95% CI, 4.02–11.11; p < 0.001), and epistaxis (OR, 2.47; 95% CI, 1.39–4.39; p = 0.002), were independent clinical risk factors of orbital floor fractures (OFFs) in head trauma patients

Summary

Introduction

As maxillofacial fractures are frequently concomitant with head trauma because of the close anatomical proximity of the facial skeleton to the cranium [1,2], orbital fractures account for a significant portion of facial trauma [3,4,5]. Among orbital fractures, the orbital floor is the most commonly involved wall due to its thin bony structure [3,4,6]. For the incidence rate of 19.7% regarding concomitant orbital fractures associated with head trauma reported in one previous study [10], if there are no or only subtle fracture-related symptoms, and if clinically patients are unable to cooperate during the ophthalmologic examination, the orbital fractures may be left undetected without ordering additional facial CT scans. The liberal use of additional facial CT surveillance in head trauma patients without clinical signs of orbital injury will lead to another issue of unnecessary radiation exposure. Patients with head trauma may have concomitant orbital floor fractures (OFFs). Unnecessary facial CT and additional radiation exposure may be reduced

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Discussion

Conclusion