Will a computed tomography (CT) maxillofacial scan show orbital fractures?

CT Maxillofacial Imaging for Orbital Fractures

Yes, CT maxillofacial is the first-line imaging modality for detecting orbital fractures and provides superb delineation of both osseous and soft-tissue orbital structures. 1

Diagnostic Capabilities

Multi-detector CT (MDCT) maxillofacial imaging excels at identifying orbital fractures through:

• High-resolution thin-section acquisitions that detect even subtle, nondisplaced fractures of the orbital walls 1
• Multiplanar and 3-D reconstructions that allow comprehensive characterization of complex orbital fracture patterns, which surgeons find critical for preoperative planning 1
• Superior contrast resolution that makes fragmented, complex fractures easier to identify compared to conventional tomography 2

Specific Orbital Structures Visualized

CT maxillofacial effectively demonstrates:

• Orbital wall fractures, with the orbital floor affected in 67% of cases 3
• Medial orbital wall comminution at the level of the lacrimal fossa in naso-orbital-ethmoid fractures 1
• Zygomaticosphenoid suture status, which indicates orbital volume changes and asymmetry 1, 4
• Soft tissue injuries including extraocular muscle displacement (44.6% of cases), ocular globe deformation (23.8%), and optic nerve elongation (12.9%) 3

Clinical Context and Frequency

• Orbital fractures occur in 5.3% to 23.6% of patients presenting with maxillofacial trauma, depending on trauma severity 5, 3
• Combined osseous and soft tissue injuries are present in 39.2% of orbital trauma cases, while isolated soft tissue injuries are rare 3
• Single or two-wall fractures are most prevalent, with the orbital floor being the most commonly affected structure 3

Critical Associated Injuries to Evaluate

When orbital fractures are identified, CT maxillofacial also screens for:

• Intracranial injury, present in 9% of patients with orbital wall fractures 1, 4
• Infraorbital nerve (V2) involvement, particularly with zygomaticomaxillary complex fractures 1
• Vascular trauma, suspected in 15.8% of orbital injury cases 3

Important Caveats

• Head CT alone detects 95% of facial fractures but often only partially images midface structures, making dedicated maxillofacial CT necessary for complete evaluation 1
• IV contrast does not aid in detection of facial or orbital fractures 1
• MRI is not indicated for initial orbital fracture evaluation, reserved only for cranial nerve deficits unexplained by CT or suspected CSF leak 1

Quantitative Assessment

CT maxillofacial enables:

• Orbital volume quantification to assess enophthalmos risk, with increases of 9.2% to 36.4% correlating with 2.5-5 mm of enophthalmos 6
• Precise measurement of orbital wall displacement to guide surgical reconstruction 6