The role of orbital ultrasound in the diagnosis of orbital fractures.

The role of CT scanning in the diagnosis and management of craniomaxillofacial injuries is well documented. However, coexistent injuries, limitations on patient positioning, CT availability, or financial constraints may prevent or delay the diagnosis of significant orbital wall defects. Real-time ultrasound represents a safe, inexpensive, noninvasive, portable, and readily available diagnostic modality which has had a limited application in the diagnosis of orbital pathology. The objectives of this study were to define the role of orbital ultrasound in the assessment of the traumatized orbit and to provide correlation of pathology with CT imaging. Eighteen patients (16 males, 2 females) having sustained trauma to the orbitozygomatic region were assessed at a regional trauma center over a 6-month period. Each patient underwent an ultrasound examination of both orbits. Confirmatory CT scans (5-mm axial and 1.5-mm coronal orbital cuts) were then obtained for comparative assessment. Patients with open globe injuries, alteration of visual acuity, or life-threatening conditions were excluded from the study. The results of the study revealed a positive correlation between the ultrasound and CT findings in 17 (94 percent) of the patients. Ultrasound demonstrated satisfactory sensitivity (92 percent) and specificity (100 percent) and positive predictive value (100 percent) when compared with CT scanning. Soft-tissue herniation, orbital emphysema, and muscle entrapment were well visualized by means of real-time ultrasound. It is concluded that orbital ultrasound is an accurate diagnostic modality in the investigation of orbital trauma and correlates well with CT findings. A cost analysis will be presented, and details of the limitations and efficacy of orbital ultrasound will be discussed.