A Single Reformatted Oblique Sagittal View as an Adjunct to Coronal Computed Tomography for the Evaluation of Orbital Floor Fractures

Purpose: We sought to determine whether it is beneficial to routinely include a single reformatted oblique sagittal view as an adjunct to coronal computed tomography (CT) for the evaluation and treatment of orbital floor fractures, when imaging is obtained on patients with orbital trauma. Materials and Methods: A retrospective analysis of 12 midface CT scans was performed. All of the patients included in the study had been determined by a staff radiologist to have radiographic evidence of orbital fractures. Five surgeons who treat orbital floor fractures, but do not routinely order oblique sagittal views, were asked to evaluate the selected CT scans without being given a clinical history. The surgeons were allowed to evaluate the reformatted coronal CT and were asked to rate their ability to determine the location and the size of the fracture in a medial-lateral dimension and an anterior-posterior dimension, volume of orbital contents herniated into the maxillary sinus, and radiographic evidence of inferior rectus entrapment. The surgeons were then allowed to evaluate a single reformatted oblique sagittal view through each orbit. They were asked the same questions and these 2 additional questions, "Do you think the oblique view gave you additional information, and would it change your treatment plan?" Results: Confidence in determining the size and location of the fracture in a medial-lateral dimension was not improved with the addition of the reformatted oblique sagittal view; however, location and size of the fracture in an anterior-posterior dimension and volume displaced from the orbit into the maxillary sinus and evidence of inferior rectus entrapment were improved with the addition to the oblique sagittal view. Seventy-eight percent of responders said that the oblique sagittal view provided additional information, and 18% of the responders said that the additional information changed the treatment plan. Conclusion: Routinely obtaining a single reformatted oblique sagittal view as an adjunct to coronal CT provides additional valuable information to the surgeon in treating orbital floor fractures. Reformatted views do not subject patients to additional radiation and the time to obtain these views is minimal.