Download PDF
Facial Plast Surg 2014; 30(05): 528-536
DOI: 10.1055/s-0034-1394098
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Imaging of the Midfacial and Orbital Trauma

Johannes Wikner
1   Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Björn Riecke
1   Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Alexander Gröbe
1   Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Max Heiland
1   Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Henning Hanken
1   Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
14 November 2014 (online)

    Permissions and Reprints

Abstract

The severity of midfacial and orbital injuries depends on the one hand on cause, force vector, load point, or area and on the other hand on the bony and soft tissue resistance as well as individual anatomy. These variables result in a variety of possible injuries of the midfacial and orbital complex. The time critical choice of an adequate imaging modality of these injuries is influenced by the possible severity of concomitant injuries. Besides the confirmation of a clinical diagnosis, the need for high-resolution three-dimensional imaging for preoperative planning of facial reconstruction using intraoperative navigation has become more and more important in the past years. To achieve optimal functional and esthetic outcomes, the anatomical complexity of the midface has to be addressed and the adequate imaging modality has to be chosen keeping the upcoming surgical treatment in mind. The current imaging modalities for midfacial and orbital trauma are presented and critically evaluated depending on the indications. Furthermore, new strategies to support surgeons in achieving best possible midfacial reconstructions are discussed. An algorithm to choose the adequate imaging modality in midfacial and orbital traumatology is provided.

Keywords

midface - orbital trauma - imaging - tomography - CBCT

Note

J. W. and H. H. are consultants. B. R. and A. G. are the senior consultants. M. H. is the head of department.


 

  • References

  • 1 Sohns JM, Staab W, Sohns C , et al. Current perspective of multidetector computed tomography (MDCT) in patients after midface and craniofacial trauma. Clin Imaging 2013; 37 (4) 728-733
    CrossrefPubMedGoogle Scholar
  • 2 Schubert J. Treatment of midfacial fractures [in German]. Radiologe 2007; 47 (7) 598 , 600–605
    CrossrefPubMedGoogle Scholar
  • 3 Karabekir HS, Gocmen-Mas N, Emel E , et al. Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects. J Craniomaxillofac Surg 2012; 40 (7) e189-e193
    CrossrefPubMedGoogle Scholar
  • 4 Manson PN, Hoopes JE, Su CT. Structural pillars of the facial skeleton: an approach to the management of Le Fort fractures. Plast Reconstr Surg 1980; 66 (1) 54-62
    CrossrefPubMedGoogle Scholar
  • 5 Friedrich RE, Heiland M, Bartel-Friedrich S. Potentials of ultrasound in the diagnosis of midfacial fractures*. Clin Oral Investig 2003; 7 (4) 226-229
    CrossrefPubMedGoogle Scholar
  • 6 Stieve M, Issing PR, Mack KF, Lenarz T, Prenzler N. Indications of intraoperative ultrasound in head and neck surgery [in German]. Laryngorhinootologie 2012; 91 (7) 422-426
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Ayoub N, Ghassemi A, Rana M , et al. Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial. Trials 2014; 15: 114
    CrossrefPubMedGoogle Scholar
  • 8 Casselman JW, Gieraerts K, Volders D , et al. Cone beam CT: non-dental applications. JBR-BTR 2013; 96 (6) 333-353
    PubMedGoogle Scholar
  • 9 Lee S, Gallia GL, Reh DD , et al. Intraoperative C-arm cone-beam computed tomography: quantitative analysis of surgical performance in skull base surgery. Laryngoscope 2012; 122 (9) 1925-1932
    CrossrefPubMedGoogle Scholar
  • 10 Cakli H, Cingi C, Ay Y, Oghan F, Ozer T, Kaya E. Use of cone beam computed tomography in otolaryngologic treatments. Eur Arch Otorhinolaryngol 2012; 269 (3) 711-720
    CrossrefPubMedGoogle Scholar
  • 11 Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 2: clinical applications. AJNR Am J Neuroradiol 2009; 30 (7) 1285-1292
    CrossrefPubMedGoogle Scholar
  • 12 Miracle AC, Mukherji SK. Conebeam CT of the head and neck, part 1: physical principles. AJNR Am J Neuroradiol 2009; 30 (6) 1088-1095
    CrossrefPubMedGoogle Scholar
  • 13 Closmann JJ, Schmidt BL. The use of cone beam computed tomography as an aid in evaluating and treatment planning for mandibular cancer. J Oral Maxillofac Surg 2007; 65 (4) 766-771
    CrossrefPubMedGoogle Scholar
  • 14 Klatt JC, Heiland M, Marx S, Hanken H, Schmelzle R, Pohlenz P. Clinical indication for intraoperative 3D imaging during open reduction of fractures of the mandibular angle. J Craniomaxillofac Surg 2013; 41 (5) e87-e90
    CrossrefPubMedGoogle Scholar
  • 15 Klatt J, Heiland M, Blessmann M, Blake F, Schmelzle R, Pohlenz P. Clinical indication for intraoperative 3D imaging during open reduction of fractures of the neck and head of the mandibular condyle. J Craniomaxillofac Surg 2011; 39 (4) 244-248
    CrossrefPubMedGoogle Scholar
  • 16 Heiland M, Pohlenz P, Blessmann M , et al. Cervical soft tissue imaging using a mobile CBCT scanner with a flat panel detector in comparison with corresponding CT and MRI data sets. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104 (6) 814-820
    CrossrefPubMedGoogle Scholar
  • 17 Kim DS, Rashsuren O, Kim EK. Conversion coefficients for the estimation of effective dose in cone-beam CT. Imaging Sci Dent 2014; 44 (1) 21-29
    CrossrefPubMedGoogle Scholar
  • 18 Lee CY, Koval TM, Suzuki JB. Low Dose Radiation Risks of CT and CBCT: Reducing the Fear and Controversy. J Oral Implantol 2014;
    PubMedGoogle Scholar
  • 19 Deman P, Atwal P, Duzenli C, Thakur Y, Ford NL. Dose measurements for dental cone-beam CT: a comparison with MSCT and panoramic imaging. Phys Med Biol 2014; 59 (12) 3201-3222
    CrossrefPubMedGoogle Scholar
  • 20 Dölekoğlu S, Fişekçioğlu E, Ilgüy D, Ilgüy M, Bayirli G. Diagnosis of jaw and dentoalveolar fractures in a traumatized patient with cone beam computed tomography. Dent Traumatol 2010; 26 (2) 200-203
    CrossrefPubMedGoogle Scholar
  • 21 Palomo L, Palomo JM. Cone beam CT for diagnosis and treatment planning in trauma cases. Dent Clin North Am 2009; 53 (4) 717-727 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 22 Shintaku WH, Venturin JS, Azevedo B, Noujeim M. Applications of cone-beam computed tomography in fractures of the maxillofacial complex. Dent Traumatol 2009; 25 (4) 358-366
    CrossrefPubMedGoogle Scholar
  • 23 Ilgüy D, Ilgüy M, Fisekcioglu E, Bayirli G. Detection of jaw and root fractures using cone beam computed tomography: a case report. Dentomaxillofac Radiol 2009; 38 (3) 169-173
    CrossrefPubMedGoogle Scholar
  • 24 Bamgbose BO, Adeyemo WL, Ladeinde AL, Ogunlewe MO. Conebeam computed tomography (CBCT): the new vista in oral and maxillofacial imaging. Nig Q J Hosp Med 2008; 18 (1) 32-35
    PubMedGoogle Scholar
  • 25 Ellis III E. Orbital trauma. Oral Maxillofac Surg Clin North Am 2012; 24 (4) 629-648
    CrossrefPubMedGoogle Scholar
  • 26 Winterton JV, Patel K, Mizen KD. Review of management options for a retrobulbar hemorrhage. J Oral Maxillofac Surg 2007; 65 (2) 296-299
    CrossrefPubMedGoogle Scholar
  • 27 Loubele M, Van Assche N, Carpentier K , et al. Comparative localized linear accuracy of small-field cone-beam CT and multislice CT for alveolar bone measurements. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105 (4) 512-518
    CrossrefPubMedGoogle Scholar
  • 28 Kyriakou Y, Kolditz D, Langner O, Krause J, Kalender W. Digital volume tomography (DVT) and multislice spiral CT (MSCT): an objective examination of dose and image quality [in German]. Rofo 2011; 183 (2) 144-153
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Loubele M, Bogaerts R, Van Dijck E , et al. Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol 2009; 71 (3) 461-468
    CrossrefPubMedGoogle Scholar
  • 30 Suomalainen A, Vehmas T, Kortesniemi M, Robinson S, Peltola J. Accuracy of linear measurements using dental cone beam and conventional multislice computed tomography. Dentomaxillofac Radiol 2008; 37 (1) 10-17
    CrossrefPubMedGoogle Scholar
  • 31 Wang JW, Tang C, Pan BR. Data analysis of low dose multislice helical CT scan in orbital trauma. Int J Ophthalmol 2012; 5 (3) 366-369
    PubMedGoogle Scholar
  • 32 Blendl C, Fiebich M, Voigt JM, Selbach M, Uphoff C. Investigation on the 3 D geometric accuracy and on the image quality (MTF, SNR and NPS) of volume tomography units (CT, CBCT and DVT) [in German]. Rofo 2012; 184 (1) 24-31
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Schulze D, Heiland M, Thurmann H, Adam G. Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography. Dentomaxillofac Radiol 2004; 33 (2) 83-86
    CrossrefPubMedGoogle Scholar
  • 34 Fuchs T, Kalender W. On the correlation of pixel noise, spatial resolution and dose in computed tomography: Theoretical prediction and verification by simulation and measurement. Phys Med 2003; 19 (2) 153-164
    PubMedGoogle Scholar
  • 35 Moshfeghi M, Tavakoli MA, Hosseini ET, Hosseini AT, Hosseini IT. Analysis of linear measurement accuracy obtained by cone beam computed tomography (CBCT-NewTom VG). Dent Res J (Isfahan) 2012; 9 (Suppl. 01) S57-S62
    PubMedGoogle Scholar
  • 36 Marmulla R, Wörtche R, Mühling J, Hassfeld S. Geometric accuracy of the NewTom 9000 Cone Beam CT. Dentomaxillofac Radiol 2005; 34 (1) 28-31
    CrossrefPubMedGoogle Scholar
  • 37 Schulze R, Heil U, Gross D , et al. Artefacts in CBCT: a review. Dentomaxillofac Radiol 2011; 40 (5) 265-273
    CrossrefPubMedGoogle Scholar
  • 38 Schulze RK, Berndt D, d'Hoedt B. On cone-beam computed tomography artifacts induced by titanium implants. Clin Oral Implants Res 2010; 21 (1) 100-107
    CrossrefPubMedGoogle Scholar
  • 39 Brown AA, Scarfe WC, Scheetz JP, Silveira AM, Farman AG. Linear accuracy of cone beam CT derived 3D images. Angle Orthod 2009; 79 (1) 150-157
    CrossrefPubMedGoogle Scholar
  • 40 Dalessandri D, Bracco P, Paganelli C, Hernandez Soler V, Martin C. Ex vivo measurement reliability using two different cbct scanners for orthodontic purposes. Int J Med Robot 2012; 8 (2) 230-242
    CrossrefPubMedGoogle Scholar
  • 41 Hofmann E, Medelnik J, Fink M, Lell M, Hirschfelder U. Three-dimensional volume tomographic study of the imaging accuracy of impacted teeth: MSCT and CBCT comparison—an in vitro study. Eur J Orthod 2013; 35 (3) 286-294
    CrossrefPubMedGoogle Scholar
  • 42 Logan H, Wolfaardt J, Boulanger P, Hodgetts B, Seikaly H. Evaluation of the accuracy of cone beam computerized tomography (CBCT): medical imaging technology in head and neck reconstruction. J Otolaryngol Head Neck Surg 2013; 42: 25
    CrossrefPubMedGoogle Scholar
  • 43 Kreidl KO, Kim DY, Mansour SE. Prevalence of significant intraocular sequelae in blunt orbital trauma. Am J Emerg Med 2003; 21 (7) 525-528
    CrossrefPubMedGoogle Scholar
  • 44 Korinth MC, Ince A, Banghard W, Huffmann BC, Gilsbach JM. Pterional orbita decompression in orbital hemorrhage and trauma. J Trauma 2002; 53 (1) 73-78
    CrossrefPubMedGoogle Scholar
  • 45 Gerbino G, Ramieri GA, Nasi A. Diagnosis and treatment of retrobulbar haematomas following blunt orbital trauma: a description of eight cases. Int J Oral Maxillofac Surg 2005; 34 (2) 127-131
    PubMedGoogle Scholar
  • 46 Kubal WS. Imaging of orbital trauma. Radiographics 2008; 28 (6) 1729-1739
    CrossrefPubMedGoogle Scholar
  • 47 Drage NA, Sivarajasingam V. The use of cone beam computed tomography in the management of isolated orbital floor fractures. Br J Oral Maxillofac Surg 2009; 47 (1) 65-66
    CrossrefPubMedGoogle Scholar
  • 48 Brisco J, Fuller K, Lee N, Andrew D. Cone beam computed tomography for imaging orbital trauma—image quality and radiation dose compared with conventional multislice computed tomography. Br J Oral Maxillofac Surg 2014; 52 (1) 76-80
    CrossrefPubMedGoogle Scholar
  • 49 Lewandowski RJ, Rhodes CA, McCarroll K, Hefner L. Role of routine nonenhanced head computed tomography scan in excluding orbital, maxillary, or zygomatic fractures secondary to blunt head trauma. Emerg Radiol 2004; 10 (4) 173-175
    CrossrefPubMedGoogle Scholar
  • 50 Exadaktylos AK, Sclabas GM, Smolka K , et al. The value of computed tomographic scanning in the diagnosis and management of orbital fractures associated with head trauma: a prospective, consecutive study at a level I trauma center. J Trauma 2005; 58 (2) 336-341
    CrossrefPubMedGoogle Scholar
  • 51 Essig H, Dressel L, Rana M , et al. Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. Head Face Med 2013; 9 (1) 18
    CrossrefPubMedGoogle Scholar
  • 52 Metzger MC, Hohlweg-Majert B, Schön R , et al. Verification of clinical precision after computer-aided reconstruction in craniomaxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104 (4) e1-e10
    PubMedGoogle Scholar
  • 53 Rudman K, Hoekzema C, Rhee J. Computer-assisted innovations in craniofacial surgery. Facial Plast Surg 2011; 27 (4) 358-365
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Xia JJ, Gateno J, Teichgraeber JF. A new paradigm for complex midface reconstruction: a reversed approach. J Oral Maxillofac Surg 2009; 67 (3) 693-703
    CrossrefPubMedGoogle Scholar
  • 55 Bell RB, Markiewicz MR. Computer-assisted planning, stereolithographic modeling, and intraoperative navigation for complex orbital reconstruction: a descriptive study in a preliminary cohort. J Oral Maxillofac Surg 2009; 67 (12) 2559-2570
    CrossrefPubMedGoogle Scholar
  • 56 Pohlenz P, Blessmann M, Blake F, Heinrich S, Schmelzle R, Heiland M. Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 (3) 412-417
    CrossrefPubMedGoogle Scholar
  • 57 Heiland M, Schulze D, Blake F, Schmelzle R. Intraoperative imaging of zygomaticomaxillary complex fractures using a 3D C-arm system. Int J Oral Maxillofac Surg 2005; 34 (4) 369-375
    CrossrefPubMedGoogle Scholar