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Orbital injury in severe trauma - CT findings

  • In our retrospective study we researched for possible injuries to the eye and orbit in patients who suffered from polytrauma. We assessed 6,000 patients with severe trauma, who were treated at the Unfallkrankenhaus Berlin (UKB) between February 2006 and August 2014. Out of them, 1,061 maxillofacial CT scans were performed additionally to a whole-body scan as further injuries to eye and/or orbit could clinically not be excluded. We used a systemic diagnostic workup to examine the frequency and severity of a trauma to osseous and soft tissue structures of the orbit. For the assessment of the bony orbital walls we included the detection of a fracture gap, a rough dislocation of bony fragments as well as the detonation of osseous sutures between facial bones. Concerning the orbital soft tissue structures we looked at injuries of the ocular globe including the lens, extraocular muscles, optic nerve and orbital vessels. Complementary, we collected clinical data of eye examinations of our patients by using the medical information system (MIS) software medico. We appraised the ophthalmic diagnostic findings based on three criteria: the intraocular pressure (IOP), the vision and eye movements and recorded whether surgery or conservative treatment was conducted. Out of 1,061 maxillofacial CT images, 811 were excluded. 668 patients did not have a trauma to the midface and 143 patients only showed fractures of the nose and/or jaw. The remaining 250 patients revealed traumata to the orbit: 149 CT scans showed fractures of the orbital cavity without participation of soft tissue structures. Three patients presented with pure soft tissue traumata to the eye and 98 scans displayed combined injuries of bones and orbital soft tissue structures. The right orbit was concerned in 35.6%, the left orbit in 32.8% and both orbits in 31.6% of cases. The prevailing type of fracture was the single wall fracture, followed by two- and three-walled fractures. In the majority of cases the orbital roof, floor or lateral wall were concerned. Besides blow-out fractures, we detected characteristic fractures as the tripod fracture and Le Fort 2°. Regarding the soft tissue traumata of 101 CT scans, we detected an unshaped vitreous body in 23.8% and a (partially) ruptured globe in 6.9%. The ocular lens was dislocated in six cases (5.9%). A foreign body pre-orbital and within the conus was found three times. Considering the extraocular muscles, we discovered that 44.6% of muscles were dislocated. In 7.9% extraocular muscles were pierced by bone, in one case the muscle was pierced by a foreign body. Searching for structural alterations of the optic nerve, 12.9% of 101 scans presented an elongated optic nerve and 9.9% revealed an altered morphology. One nerve was transected by a metallic foreign body. Upon closer inspection of orbital vessels, we detected 9.9% prominent ophthalmic veins and 5.9% posttraumatic dCCF out of 101 CT scans. The results of the clinical eye examinations showed that 19.2% of the collective of 250 patients presented with an increased IOP. 4.8% of 250 patients had a reduced or lost vision and 10% of patients had suffered from a limited ocular movement after trauma to the midface. In conclusion, approximately 9.5% from 1,061 polytrauma patients presented with associated orbital injuries. Ocular injuries are not often given immediate concern as patients with life-threatening conditions need to be stabilized first. Undetected serious eye injuries might lead to a reduced or lost vision, which could result in severe limitations of quality of life. The results of our study speak in favor for early ophthalmological consultations and radiological imaging. Diagnostic and treatment of possible orbital injuries should be remembered in a polytrauma patient.
  • In unserer retrospektiven Studie analysierten wir anhand der Dünnschicht- CT des Mittelgesichts Verletzungen des Auges und der Orbita bei Patienten, die ein Polytrauma erlitten haben. Insgesamt untersuchten wir 6,000 Patienten mit einem Polytrauma CT, welche von Februar 2006 bis August 2014 am Unfallkrankenhaus Berlin (UKB) behandelt worden sind. 9.5% von 1,061 Patienten mit einem Mittelgesicht CT präsentierten Verletzungen der Orbita. Unerkannte Verletzungen des Auges können zu einem Sehverlust führen und die Lebensqualität des Patienten stark einschränken. Daher sind eine frühe ophthalmologische Konsultation sowie eine radiologische Bildgebung bei Verdacht orbitaler Verletzungen indiziert.

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Metadaten
Author: Stephanie Heske
URN:urn:nbn:de:gbv:9-opus-36534
Title Additional (German):Orbitale Verletzungen durch ein Polytrauma - CT Befunde
Referee:Dr. med. Michael Kirsch, Prof. Dr. med. Arne-Jörn Lemke
Advisor:Dr. med. Michael Kirsch
Document Type:Doctoral Thesis
Language:English
Year of Completion:2019
Date of first Publication:2020/04/28
Granting Institution:Universität Greifswald, Universitätsmedizin
Date of final exam:2020/04/06
Release Date:2020/04/28
Tag:CT, orbital injury, polytrauma
GND Keyword:Orbital , Verletzung , Trauma , Computertomografie , Bruch , Sehnerv
Pagenumber:45
Faculties:Universitätsmedizin / Institut für Diagnostische Radiologie
DDC class:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin und Gesundheit