Role of three-dimensional computed tomography in the assessment of nasoorbitoethmoidal fractures

Successful management of nasoorbitoethmoidal (NOE) fractures requires early diagnosis and accurate determination of the extent of injury. Although the anatomic complexity of the NOE region merits a clear interpretation of the spatial relationships associated with each injury, the role of three-dimen sional (3D) computed tomography (CT) in the assessment of these fractures r emains unclear. To clarify the diagnostic value of 3D CT, this retrospectiv e analysis compares statistically the accuracy of two-dimensional (2D) CT a gainst 3D CT in the detection of NOE fracture line tracts in 21 consecutive patients with surgically confirmed NOE fractures. Accuracy of radiographic findings of both modalities were compared with intraoperative findings ser ving as the "gold standard" for detecting fracture lines in NOE fractures. This statistical analysis indicates that combining 3D CT and 2D CT produces a higher diagnostic yield in the evaluation of NOE fractures than using ei ther modality alone. Although 2D CT was significantly superior (p < 0.05) f or inspection of the medial orbital wall, 3D CT offered significantly great er diagnostic accuracy (p < 0.05) along the medial maxillary buttress, part icularly at the piriform aperture. 3D CT clarified spatially several unusua l NOE injuries that were indiscernible with 2D CT alone. We recommend the c ombination of 3D CT with 2D CT for serious NOE injuries, particularly those involving displacement of the NOE complex or associated with other major m idfacial fractures.