Magnetic Resonance Imaging: An Accurate, Radiation-Free, Alternative to Computed Tomography for the Primary Imaging and Three-Dimensional Reconstruction of the Bony Orbit

Intelligent surgical planning for automatic reconstruction of orbital blowout fracture using a prior adversarial generative network

Orbital blowout fracture (OBF) is a disease that can result in herniation of orbital soft tissue, enophthalmos, and even severe visual dysfunction. Given the complex and diverse types of orbital wall fractures, reconstructing the orbital wall presents a significant challenge in OBF repair surgery. Accurate surgical planning is crucial in addressing this issue. However, there is currently a lack of efficient and precise surgical planning methods. Therefore, we propose an intelligent surgical planning method for automatic OBF reconstruction based on a prior adversarial generative network (GAN). Firstly, an automatic generation method of symmetric prior anatomical knowledge (SPAK) based on spatial transformation is proposed to guide the reconstruction of fractured orbital wall. Secondly, a reconstruction network based on SPAK-guided GAN is proposed to achieve accurate and automatic reconstruction of fractured orbital wall. Building upon this, a new surgical planning workflow based on the proposed reconstruction network and 3D Slicer software is developed to simplify the operational steps. Finally, the proposed surgical planning method is successfully applied in OBF repair surgery, verifying its reliability. Experimental results demonstrate that the proposed reconstruction network achieves relatively accurate automatic reconstruction of the orbital wall, with an average DSC of 92.35 ± 2.13% and a 95% Hausdorff distance of 0.59 ± 0.23 mm, markedly outperforming the compared state-of-the-art networks. Additionally, the proposed surgical planning workflow reduces the traditional planning time from an average of 25 min and 17.8 s to just 1 min and 35.1 s, greatly enhancing planning efficiency. In the future, the proposed surgical planning method will have good application prospects in OBF repair surgery.

Semiautomated MRI-Based Method for Orbital Volume and Contour Analysis

PURPOSE

The architecture of the orbital cavity is intricate, and precise measurement of its growth is essential for managing ocular and orbital pathologies. Most methods for those measurements are by CT imaging, although MRI for soft tissue assessment is indicated in many cases, specifically pediatric patients. This study introduces a novel semiautomated MRI-based approach for depicting orbital shape and dimensions.

DESIGN

A retrospective cohort study.

PARTICIPANTS

Patients with at least 1 normal orbit who underwent both CT and MRI imaging at a single center from 2015 to 2023.

METHODS

Orbital dimensions included volume, horizontal and vertical lengths, and depth. These were determined by manual segmentation followed by 3-dimensional image processing software.

MAIN OUTCOME MEASURES

Differences in orbital measurements between MRI and CT scans.

RESULTS

Thirty-one patients (mean age 47.7 ± 23.8 years, 21 [67.7%]) females, were included. The mean differences in delta values between orbital measurements on CT versus MRI were: volume 0.03 ± 2.01 ml, horizontal length 0.53 ± 2.12 mm, vertical length, 0.36 ± 2.53 mm, and depth 0.97 ± 3.90 mm. The CT and. MRI orbital measurements were strongly correlated: volume (r = 0.92, p < 0.001), horizontal length (r = 0.65, p < 0.001), vertical length (r = 0.57, p = 0.001), and depth (r = 0.46, p = 0.009). The mean values of all measurements were similar on the paired-samples t test: p = 0.9 for volume (30.86 ± 5.04 ml on CT and 30.88 ± 4.92 ml on MRI), p = 0.2 for horizontal length, p = 0.4 for vertical length, and p = 0.2 for depth.

CONCLUSIONS

We present an innovative semiautomated method capable of calculating orbital volume and demonstrating orbital contour by MRI validated against the gold standard CT-based measurements. This method can serve as a valuable tool for evaluating diverse orbital processes.

Magnetic resonance imaging in paediatric ocular and orbital lesions: A pictorial review

Paediatric orbital lesions encompass a wide spectrum of benign and malignant entities that can arise from different components of the orbit. Clinical symptoms and signs are often nonspecific, and imaging plays a crucial role in the diagnosis and management. Ultrasonography has a limited role and radiation is a major concern with CT especially in the paediatric population. MRI is the modality of choice that avoids the radiation hazard and provides superior soft tissue contrast. The lesions can be localized using the 'compartment' approach which helps to narrow the list of differentials. MRI also provides critical information for management such as presence of perineural spread and intracranial extension. This article depicts the spectrum of Magnetic Resonance imaging findings encountered in paediatric ocular and orbital lesions.

Are Magnetic Resonance Imaging-Generated 3Dimensional Models Comparable to Computed Tomography-Generated 3Dimensional Models for Orbital Fracture Reconstruction? An In-Vitro Volumetric Analysis

BACKGROUND

Magnetic resonance imaging (MRI) is being increasingly considered as an alternative for the evaluation and reconstruction of orbital fractures. No previous research has compared the orbital volume of an MRI-imaged, three-dimensional (3D), reconstructed, and virtually restored bony orbit to the gold standard of computed tomography (CT).

PURPOSE

To measure the orbital volumes generated from MRI-based 3D models of fractured bony orbits with virtually positioned prebent fan plates in situ and compare them to the volumes of CT-based virtually reconstructed orbital models.

STUDY DESIGN

This retrospective in-vitro study used CT and MRI data from adult patients with orbital trauma assessed at the Royal Brisbane and Women's Hospital Outpatient Maxillofacial Clinic from 2011 to 2012. Only those with orbital blowout fractures were included in the study.

PREDICTOR VARIABLE

The primary predictor variable was imaging modality, with CT- and MRI-based 3D models used for plate bending and placement.

MAIN OUTCOME VARIABLE

The primary outcome variable was the orbital volume of the enclosed 3D models.

COVARIATES

Additional data collected was age, sex, and side of fractured orbit. The effect of operator variability on plate contouring and orbital volume was quantified.

ANALYSES

The Wilcoxon signed rank test was used to assess differences between orbital volumes with a significance level P < .05.

RESULTS

Of 11 eligible participants, six patients (four male and two female; mean age 31 ± 8.6 years) were enrolled. Two sets of six CT-based virtually restored orbits were smaller than the intact contralateral CT models by an average of 1.02 cm3 (95% CI -0.07 to 2.11 cm3; P = .028) and 0.99 cm3 (95% CI 0.07 to 1.91 cm3; P = .028), respectively. The average volume difference between the MRI-based virtually restored orbit and the intact contralateral MRI model was 0.97 cm3 (95% CI -1.08 to 1.94 cm3; P = .75). Imaging modality did affect orbital volume difference for 1 set of CT and MRI models (0.63 cm3; 95% CI -0.11 to 1.29 cm3; P = .046) but not the other (0.69 cm3; 95% CI -0.11 to 1.23 cm3; P = .075). Single operator variability in plate bending did not result in significant (P = .75) volume differences.

CONCLUSIONS

MRI can be used to reconstruct orbital volume with a clinically acceptable level of accuracy.

Automatic Segmentation of Bone Selective MR Images for Visualization and Craniometry of the Cranial Vault

RATIONALE AND OBJECTIVES

Solid-state MRI has been shown to provide a radiation-free alternative imaging strategy to CT. However, manual image segmentation to produce bone-selective MR-based 3D renderings is time and labor intensive, thereby acting as a bottleneck in clinical practice. The objective of this study was to evaluate an automatic multi-atlas segmentation pipeline for use on cranial vault images entirely circumventing prior manual intervention, and to assess concordance of craniometric measurements between pipeline produced MRI and CT-based 3D skull renderings.

MATERIALS AND METHODS

Dual-RF, dual-echo, 3D UTE pulse sequence MR data were obtained at 3T on 30 healthy subjects along with low-dose CT images between December 2018 to January 2020 for this prospective study. The four-point MRI datasets (two RF pulse widths and two echo times) were combined to produce bone-specific images. CT images were thresholded and manually corrected to segment the cranial vault. CT images were then rigidly registered to MRI using mutual information. The corresponding cranial vault segmentations were then transformed to MRI. The "ground truth" segmentations served as reference for the MR images. Subsequently, an automated multi-atlas pipeline was used to segment the bone-selective images. To compare manually and automatically segmented MR images, the Dice similarity coefficient (DSC) and Hausdorff distance (HD) were computed, and craniometric measurements between CT and automated-pipeline MRI-based segmentations were examined via Lin's concordance coefficient (LCC).

RESULTS

Automated segmentation reduced the need for an expert to obtain segmentation. Average DSC was 90.86 ± 1.94%, and average 95th percentile HD was 1.65 ± 0.44 mm between ground truth and automated segmentations. MR-based measurements differed from CT-based measurements by 0.73-1.2 mm on key craniometric measurements. LCC for distances between CT and MR-based landmarks were vertex-basion: 0.906, left-right frontozygomatic suture: 0.780, and glabella-opisthocranium: 0.956 for the three measurements.

CONCLUSION

Good agreement between CT and automated MR-based 3D cranial vault renderings has been achieved, thereby eliminating the laborious manual segmentation process. Target applications comprise craniofacial surgery as well as imaging of traumatic injuries and masses involving both bone and soft tissue.

A deep learning method for automatic segmentation of the bony orbit in MRI and CT images

This paper proposes a fully automatic method to segment the inner boundary of the bony orbit in two different image modalities: magnetic resonance imaging (MRI) and computed tomography (CT). The method, based on a deep learning architecture, uses two fully convolutional neural networks in series followed by a graph-search method to generate a boundary for the orbit. When compared to human performance for segmentation of both CT and MRI data, the proposed method achieves high Dice coefficients on both orbit and background, with scores of 0.813 and 0.975 in CT images and 0.930 and 0.995 in MRI images, showing a high degree of agreement with a manual segmentation by a human expert. Given the volumetric characteristics of these imaging modalities and the complexity and time-consuming nature of the segmentation of the orbital region in the human skull, it is often impractical to manually segment these images. Thus, the proposed method provides a valid clinical and research tool that performs similarly to the human observer.

Facial Reconstruction: A Systematic Review of Current Image Acquisition and Processing Techniques

Introduction: Plastic and reconstructive surgery is based on a culmination of technological advances, diverse techniques, creative adaptations and strategic planning. 3D imaging is a modality that encompasses several of these criteria while encouraging the others. Imaging techniques used in facial imaging come in many different modalities and sub-modalities which is imperative for such a complex area of the body; there is a clear clinical need for hyper-specialized practice. However, with this complexity comes variability and thus there will always be an element of bias in the choices made for imaging techniques. Aims and Objectives: The aim of this review is to systematically analyse the imaging techniques used in facial reconstruction and produce a comprehensive summary and comparison of imaging techniques currently available, including both traditional and novel methods. Methods: The systematic search was performed on EMBASE, PubMed, Scopus, Web of Science and Cochrane reviews using keywords such as "image technique/acquisition/processing," "3-Dimensional," "Facial," and "Reconstruction." The PRISMA guidelines were used to carry out the systematic review. Studies were then subsequently collected and collated; followed by a screening and exclusion process with a final full-text review for further clarification in regard to the selection criteria. A risk of bias assessment was also carried out on each study systematically using the respective tool in relation to the study in question. Results: From the initial 6,147 studies, 75 were deemed to fulfill all selection criteria and selected for meta-analysis. The majority of papers involved the use of computer tomography, though the use of magnetic resonance and handheld scanners using sonography have become more common in the field. The studies ranged in patient population, clinical indication. Seminal papers were highlighted within the group of papers for further analysis. Conclusions: There are clearly many factors that affect the choice of image acquisition techniques and their potential at being ideal for a given role. Ultimately the surgical team's choice will guide much of the decision, but it is crucial to be aware of not just the diagnostic ability of such modalities, but their treatment possibilities as well.

Dynamic three-dimensional finite element analysis of orbital trauma

This study comprises a dynamic finite element (FE) analysis of the mechanisms of orbital trauma, specifically buckling and hydraulic theories. A digital model of the orbital cavity - including the eyeball, fatty tissue, extraocular muscles, and the bone orbit - was created from magnetic resonance imaging and computed tomographic data from a real patient. An impactor hit the FE model following two scenarios: one was a hydraulic mechanism for direct impact to the eyeball and the other a buckling mechanism for direct impact over the infraorbital rim. The first principal stress was calculated to determine the stress distribution over the orbital walls. The FE model presented more than 900,000 elements and time of simulation was 4.8 milliseconds (ms) and 0.6 ms, for the hydraulic and buckling mechanisms, respectively. The stress distribution in the hydraulic mechanism affected mainly the medial wall with a high stress area of 99.08 mm², while the buckling mechanism showed a high stress area of 378.70 mm² in the orbital floor. The presence of soft tissue absorbed the energy, especially in the hydraulic mechanism. In conclusion, the applied method of segmentation allowed the construction of a complete orbital model. Both mechanisms presented results that were similar to classic experiments. However, the soft tissue in the hydraulic mechanism absorbed the impact, demonstrating its role in orbital pathophysiology.

Semi-automatic magnetic resonance imaging based orbital fat volumetry: reliability and correlation with computed tomography

Post-processing analysis can provide valuable information for diagnosis and planning of orbital disorders. This cross-sectional study aims to evaluate the reliability of semi-automatic, orbital fat volumetry using magnetic resonance imaging (MRI). Two observers assessed the orbital fat volume using a standard MRI protocol (3T, T1w sequence) in 12 orbits diagnosed with Graves' orbitopathy (GO) and 10 healthy control orbits. MRI and computed tomography (CT) based analysis were compared. Intra-observer variability was good (intraclass correlation coefficient (ICC) 0.88; 95% confidence interval (CI) [0.70, 0.95]) and interobserver agreement was moderate (ICC 0.55; 95% CI [-0.09, 0.81]), which corresponds to a mean percentage difference of 1.3% and 17.9% of the total orbital fat volume. Mean differences between MRI and CT measurements were, respectively, 1.1 cm³ (P= 0.064, 95% CI [-0.20, 2.43]) and 1.4 cm³ (P=0.016, 95% CI [0.21, 2.56]) for the control and the GO group. MRI volumetry was strongly correlated with CT (Pearson's r= 0.7, P<0.001). We conclude that orbital fat volumetry is feasible with a semi-automatic segmentation procedure and standard MRI protocol. Correlation with CT volumetry is good, but considerable bias may derive from observer variability and these errors should be taken into account for the purpose of volumetric analysis. Better definition of error sources may increase measurement accuracy.

Magnetic resonance imaging for three-dimensional printing of the bony orbit: is clinical use imminent?

The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.

The 'White-eyed' Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma

The ‘white-eyed’ blowout fracture (WEBOF) is an injury that is often overlooked in head trauma patients, as it often has few overt clinical and radiographic features. Although benign in appearance, it can lead to significant patient morbidity. Here, we intend to increase the awareness of WEBOF and provide general principles for its diagnosis. WEBOF should be recognized early to ensure timely management and a successful outcome.

Dose reduction in CT imaging for facial bone trauma in adults: A narrative literature review

Trauma to the facial area accounts for a significant number of admissions to the emergency department. Diagnostic imaging is almost always required, and is critical in determining patient management. Multi‐detector computed tomography (MDCT) appears consistently in the literature as the gold‐standard imaging modality for facial bones, but results in a high radiation dose to the patient. This makes the application and advancement of dose reduction and dose optimisation methods vital. This narrative review presents a critical analysis of the literature concerning diagnostic imaging of facial bone trauma, with an emphasis on dose reduction methods for MDCT. Databases including Pubmed, Medline, Web of Science and Scopus were used to investigate this topic, with the key words: facial bone trauma, computed tomography (CT) imaging and dose reduction. Exclusion criteria included studies on nasal bone fracturing, dental imaging, elective surgeries and paediatric imaging. The literature shows overwhelming support for MDCT, given its accuracy, efficiency and ease of operation. Noise reducing reconstruction algorithms show promise as a successful method of dose reduction in facial bone imaging. Investigations of more innovative techniques also appear within the literature, including diagnostic cone‐beam CT (CBCT), intraoperative CBCT and dual‐source CT (DSCT), but further research is required to confirm their clinical value.

Delayed surgical treatment of orbital trapdoor fracture in paediatric patients

BACKGROUND

Trapdoor fracture is a special type of orbital blowout fracture. Although early surgery is recommended, there still remain some patients delayed by various reasons. In this study, we analysed the clinical characteristics of delayed paediatric patients, especially those with different levels of ocular motility restriction before surgery.

METHODS

Thirty patients (3 to 14 years old) who underwent delayed surgery for trapdoor fractures between January 2008 and September 2016 were enrolled. Their demographics, causes of injury and delay, clinical features, imaging data and follow-up information were collected.

RESULTS

Muscular entrapment was found in 17 patients (group A) and soft-tissue entrapment in 13 patients (group B). 12 (7 in group A) presented with severe motility restriction and 18 (10 in group A) with mild restriction before surgery. 41.7% with severe restriction recovered after surgery, compared with 83.3% with mild restriction. Four (23.7%) in group A (all with severe restriction) and six (46.2%) in group B (half with severe restriction) presented with persistent diplopia.

CONCLUSIONS

Long recovery time and a high percentage of persistent diplopia are the main problems of delayed trapdoor fracture in children. A prompt surgery within 48 hours is strongly recommended in patients with muscular entrapment even if an urgent treatment is hard to achieve. So are patients with soft-tissue entrapment and significant motility restriction. In the other patients without such indications, even though some recovery might be possible in the long term, a prompt surgery right after diagnosis is still preferable regardless of the entrapped contents.

Establishment of magnetic resonance imaging 3D reconstruction technology of orbital soft tissue and its preliminary application in patients with thyroid-associated ophthalmopathy

OBJECTIVE

Effective management of thyroid-associated ophthalmopathy (TAO) requires precise identification of the disease activity period as it is responsive to immunosuppressive treatment. Quantitative evaluations of orbital soft tissue are useful for analysing disease stages. We aimed to establish a method for orbital soft tissue volume calculation based on magnetic resonance imaging (MRI) data using 3D reconstruction technology. Furthermore, we validated the accuracy and precision of this method and investigated volume differences between patients with TAO and healthy individuals.

MATERIALS AND METHODS

Using Mimics software for 3D reconstruction based on orbital MRI data, we quantitatively measured orbital fat volume (FV) and extraocular muscle volume (MV) using a manual phantom, and in patients with TAO and healthy volunteers (n = 10 each). The phantom was made using a combination of butter and chicken muscle and 2 observers measured its volume. Volume calculations were compared to a previously established standard volume. One observer measured a typical TAO case 10 times to calculate intra-observer variability while 3 observers independently measured 10 patients with TAO each to calculate interobserver variability. Orbital soft tissue volumes between 10 patients with TAO and 10 healthy individuals were compared.

RESULTS

The precision of calculations for the phantom between the 2 observers varied from -4.60% to -2.78% for FV and between -4.13% to 0.71% for MV. Mean differences among repetitive calculations were lower than 4%, except during measurement of MV, which was 5.84%. The intraclass correlation coefficient varied from 0.976 to 0.996. FV was 15.53 ± 3.06 mL in patients with TAO and 11.32 ± 1.68 mL(P = .001)in healthy individuals, while MV was 3.19 ± 0.82 mL in patients with TAO and 2.45 ± 0.57 mL(P = .030)in healthy individuals.

CONCLUSIONS

This method of calculating orbital soft tissue volumes based on MRI data and 3D reconstruction is both reliable and accurate as it yielded significant differences in tissue volume between patients with TAO and healthy individuals.

Does the Addition of a "Black Bone" Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children?

BACKGROUND AND PURPOSE

Head CT is the current neuroimaging tool of choice in acute evaluation of pediatric head trauma. The potential cancer risks of CT-related ionizing radiation should limit its use in children. We evaluated the role of MR imaging, including a "black bone" sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma.

MATERIALS AND METHODS

We performed a retrospective evaluation of 2D head CT and brain MR imaging studies including the black bone sequence of children with head trauma. Two experienced pediatric neuroradiologists in consensus created the standard of reference. Another pediatric neuroradiologist blinded to the diagnosis evaluated brain MR images and head CT images in 2 separate sessions. The presence of skull fractures and intracranial posttraumatic hemorrhages was evaluated. We calculated the sensitivity and specificity of CT and MR imaging with the black bone sequence in the diagnosis of skull fractures and intracranial hemorrhages.

RESULTS

Twenty-eight children (24 boys; mean age, 4.89 years; range, 0-15.5 years) with head trauma were included. MR imaging with the black bone sequence revealed lower sensitivity (66.7% versus 100%) and specificity (87.5% versus 100%) in identifying skull fractures. Four of 6 incorrectly interpreted black bone MR imaging studies showed cranial sutures being misinterpreted as skull fractures and vice versa.

CONCLUSIONS

Our preliminary results show that brain MR imaging complemented by a black bone sequence is a promising nonionizing alternative to head CT for the assessment of skull fractures in children. However, accuracy in the detection of linear fractures in young children and fractures of aerated bone remains limited.

The accuracy of ultrashort echo time MRI sequences for medical additive manufacturing

OBJECTIVES

Additively manufactured bone models, implants and drill guides are becoming increasingly popular amongst maxillofacial surgeons and dentists. To date, such constructs are commonly manufactured using CT technology that induces ionizing radiation. Recently, ultrashort echo time (UTE) MRI sequences have been developed that allow radiation-free imaging of facial bones. The aim of the present study was to assess the feasibility of UTE MRI sequences for medical additive manufacturing (AM).

METHODS

Three morphologically different dry human mandibles were scanned using a CT and MRI scanner. Additionally, optical scans of all three mandibles were made to acquire a "gold standard". All CT and MRI scans were converted into Standard Tessellation Language (STL) models and geometrically compared with the gold standard. To quantify the accuracy of the AM process, the CT, MRI and gold-standard STL models of one of the mandibles were additively manufactured, optically scanned and compared with the original gold-standard STL model.

RESULTS

Geometric differences between all three CT-derived STL models and the gold standard were <1.0 mm. All three MRI-derived STL models generally presented deviations <1.5 mm in the symphyseal and mandibular area. The AM process introduced minor deviations of <0.5 mm.

CONCLUSIONS

This study demonstrates that MRI using UTE sequences is a feasible alternative to CT in generating STL models of the mandible and would therefore be suitable for surgical planning and AM. Further in vivo studies are necessary to assess the usability of UTE MRI sequences in clinical settings.

Objective Assessment of the Precision, Accuracy, and Reliability of a Measurement Method for Keloid Scar Volume (PARKS Study)

BACKGROUND

There is no accepted and validated method for quantitatively measuring keloid scar volume.

OBJECTIVE

The goal of this study was to develop a measurement method for ear keloid scar volume that is economical, practical, safe, reproducible, accurate, and precise.

METHODS

Ten synthetic keloids of various shapes and sizes were temporarily attached to the ears of 5 subjects. Three study raters molded each of the attached synthetic keloids and surrounding tissue of each of the subjects twice using a polyvinyl siloxane dental impression material to form a negative impression of the keloid. Once the impression material cured, the mold was removed from the subjects' ears and randomized for measurement by study raters. Molds were filled with distilled water and weighed to obtain the weight of water required to fill the impression of the keloid.

RESULTS

The test method defined by this study accurately and precisely measures the volume of a focal protrusion extending beyond the normal surface plane of a test subject's ear. The calculated intrarater correlation coefficient values for both the intrarater and interrater reliabilities were >0.75.

CONCLUSION

The techniques and methods used in this study resulted in an accurate and reliable method for measuring ear keloid scar volumes.

Inaugural Survey on Practice Patterns of Orbital Floor Fractures for American Oral and Maxillofacial Surgeons

PURPOSE

In recent years, several studies have reported on practitioners' preferences for the treatment of orbital floor fractures, showing widely varying practice patterns. The purpose of the present study was to identify the practice patterns among oral and maxillofacial surgeons involved in the management of orbital floor fractures in the United States and compare them with the available published data.

MATERIALS AND METHODS

An anonymous survey was created and electronically mailed to surgeons. We also reviewed the published data on orbital floor fractures using a PubMed and MEDLINE search. The responses to the survey were analyzed using descriptive statistics.

RESULTS

The factors that had the greatest influence on the surgeon's decision to operate were a defect size > 2 cm2, enophthalmos, entrapment, and persistent diplopia. The most common surgical approach reported was a preseptal transconjunctival approach (32.0%), followed by the subciliary (27.9%) and postseptal transconjunctival (26.2%) approaches. The most commonly reported implant for orbital reconstruction was titanium (65.4%), followed by Medpor (43.7%) and composite Medpor and titanium (26.4%). The review of the published data showed a consensus among many of the operative indications mentioned, including a large defect size, enophthalmos, clinical entrapment, and persistent diplopia.

CONCLUSIONS

Oral and maxillofacial surgeons in the United States have a wide range of practice habits in the management of orbital floor fractures. Although the quality of the available evidence is poor, it supports a consistent approach to the management of orbital floor fractures in terms of the indications and surgical approach. The choice of reconstructive material and timing of repair remain more controversial. A clear need exists for improvement in the available data to help guide and set standards of care for the specialties managing orbital floor fractures.