Computed tomography of acute orbital trauma in children: a retrospective study

INTRODUCTION: Orbital injuries account for 36 to 64% of all blunt trauma to the facial bones. Diagnosis of orbital wall fractures is carried out using conventional radiography in several projections and computed tomography; magnetic resonance imaging is less commonly used. Often, due to the small displacement of orbital bone fragments, X-ray diagnosis is difficult. Multislice CT with reconstruction of sagittal, coronal projections and 3D in the bone window in such cases is the best visualization method. However, there are still no clear indications for the use of each method and there is no complete view of the CT characteristics of orbital damage.

OBJECTIVE: To study the diagnostic value of computed tomography of orbital fractures in pediatric patients with acute trauma.

MATERIAL AND METHODS: Retro- and prospectively analyzed the results of CT scans of 94 patients with facial fractures from 01/01/2023 to 09/01/2023 to assess combined orbital injuries. Orbital fractures were detected in 63 children (67.0%). There were 44 boys (69.84%), 19 girls (30.15%) aged from 7 months to 17 years 10 months (average age 10.3). Statistics: For statistical analysis, the method of calculating the nominal correlation using the Kramer coefficient (V) using the IBM SPSS Statistics software package was used.

RESULTS: Concomitant injury was observed in 30 (47.6%); isolated 33 (52.36%). The number and frequency of fractures observed were as follows: superior wall of the orbit — 39 (61.9%); zygomatic complex — 19 (30.1%); lower wall of the orbit — 43 (68.2%); nasal bone — 17 (26.9%); lower jaw — 6 (9.5%); medial wall of the orbit — 28 (44.4%); upper jaw — 27 (42.8%); alveolar process — 6 (9.5%); isolated zygomatic arch — 14 (22.2%); Le Fort type I — 1 (1.5%); Le Fort type II — 2 (3.1%); and Le Fort type III — 0 (0%). Orbital hematomas were found in 25 patients (39.6%). It was revealed a strong correlation between the presence of contiguous skull fractures and multiple skull fractures (V=0.878, p<0.001), frontal sinus fractures and frontal sinus hemosinus (V=0.69, p<0.001).

CONCLUSION: Orbital fractures are a frequent type of facial fracture occurring in children with blunt isolated and combined trauma. In children with blunt trauma, head CT combined with clinical examination is currently the optimal tool for diagnosing clinically significant orbital injuries. There is a strong correlation between orbital hematomas and orbital vault fractures, orbital hematomas and lattice fractures, adjacent skull and orbital vault fractures, and adjacent skull and lattice fractures. CT examination should include multiplanar (in coronal and sagittal planes) and 3D reconstructions, which help to assess the extent of the fracture, the presence of diastasis, the degree of muscle impingement. Based on the data obtained, the clinician determines the need for surgical intervention.

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