THE ROLE OF ORBITAL ULTRASOUND IN THE DIAGNOSIS OF ORBITAL FRACTURES

The role of CT scanning in the diagnosis and management of craniomaxil lofacial injuries is well documented. However, CoeXiStent injuries, li mitations on patient positioning, CT availability, or financial constr aints may prevent or delay the diagnosis of significant orbital wall d efects. Real-time ultrasound represents a safe, inexpensive, noninvasi ve, portable, and readily available diagnostic modality which has had a limited application in the diagnosis of orbital pathology. The objec tives of this study were to define the role of orbital ultrasound in t he assessment of the traumatized orbit and to provide correlation of p athology with CT imaging. Eighteen patients (16 males, 2 females) havi ng sustained trauma to the orbitozygomatic region were assessed at a r egional trauma center over a 6-month period. Each patient underwent an ultrasound examination of both orbits. Confirmatory CT scans (5-mm ax ial and 1.5-mm coronal orbital cuts) were then obtained for comparativ e assessment. Patients with open globe injuries, alteration of visual acuity, or life-threatening conditions were excluded from the study. T he results of the study revealed a positive correlation between the ul trasound and CT findings in 17 (94 percent) of the patients. Ultrasoun d 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 musc le entrapment were well visualized by means of real-time ultrasound. I t is concluded that orbital ultrasound is an accurate diagnostic modal ity in the investigation of orbital trauma and correlates well with CT findings. A cost analysis will be presented, and details of the limit ations and efficacy of orbital ultrasound will be discussed.