CT parameters in pure orbital wall fractures and their relevance in the choice of treatment and patient outcome: a systematic review

Abstract

Computed tomography (CT) is commonly used for the diagnosis, treatment planning, and prognosis of pure orbital fractures of the orbital floor and medial wall. The aim of this study was to systematically review the current literature in order to establish an overview of CT parameters relevant to the choice of treatment and (long-term) clinical outcome for patients treated operatively and conservatively. The PRISMA guidelines were followed. Databases were searched using the terms 'orbital fracture' and 'computed tomography'. Studies evaluating the relationship between CT parameters and the treatment decision or clinical outcome (enophthalmos, diplopia, and/or limitation of ocular movement) were included. The search yielded 4448 results of which 31 were included (except for three, all were retrospective). The systematic use of CT imaging in orbital fractures of the floor and the medial wall can be of great value in the treatment decision and prediction of (long-term) clinical outcomes for both conservatively and surgically treated patients. The following parameters were found to be the most relevant: fracture size, fracture location, orbital volume, soft tissue involvement, and craniocaudal dimension. Although some show great individual potential, it is likely that incorporating all parameters into an algorithm will provide the best predictive power and thus would be the most practically applicable tool.

Orbital Fracture Characteristics and Outcomes in Baltimore

“…The high incidence of moderate and near-total OBF can be attributed to the high severity of the trauma experienced by our patient population. A systematic review in 2022 studying the use of CT in OBF found that of 31 studies most showed a significant correlation between increasing fracture size and a worse clinical outcome 13 . Hence, we used fracture size as a surrogate for fracture severity in our analysis.…”

“…A systematic review in 2022 studying the use of CT in OBF found that of 31 studies most showed a significant correlation between increasing fracture size and a worse clinical outcome. 13 Hence, we used fracture size as a surrogate for fracture severity in our analysis.…”

“…Fracture size was categorized as small (< 2 cm 2 defect and < 3 mm displacement), moderate ( > 2 cm 2 defect and > 3 mm displacement), or neartotal defect, as established by previous studies in OBF literature. 12,13 Fracture size was measured by 2 authors, trained by a radiologist, to minimize interrater variability. Fractures were also categorized according to the orbital bone involved (roof, lateral wall, floor, medial wall, and orbital rim).…”

Orbital Fractures: A New CT-Based Protocol to Guide the Surgical Approach and Reconstruction Material Decision-Making

“…1,4 At the time of this writing, this decision is most often made by the individual clinician based on personal judgment, clinical findings, and radiological imaging. 5 Preoperative computer-assisted planning and intraoperative navigation are becoming increasingly popular for orbital fracture treatment. These technologies had proven to be helpful tools to support the surgeon in treatment in an attempt to optimize orbital reconstruction.…”

“…At the time of this writing, this decision is most often made by the individual clinician based on personal judgment, clinical findings, and radiological imaging 5 …”