Computed tomography is commonly used to evaluate patients with blunt facial trauma. With the high definition of the current scanners, even small fractures of the facial skeleton can be visualized. In complex midface injuries, it can be difficult for the radiologist to know which fractures are important to point out to the surgeon. An understanding of the anatomically relevant and surgically accessible craniofacial buttresses is critical for management of these injuries. Naso-orbitoethmoid fractures are classified according to the degree of injury to the medial canthal attachment. If the nasofrontal ducts are disrupted, surgical obliteration of the frontal sinus is needed to prevent formation of a mucocele. Displaced fractures of the zygomaticomaxillary complex often increase orbital volume due to angulation of the lateral orbital wall at the zygomaticosphenoid suture. If the zygomatic arch is severely comminuted or angulated, surgical exposure is indicated. In orbital fractures, the position and shape of the medial and inferior rectus muscles can indicate whether entrapment and diplopia are likely. Pediatric “trapdoor” orbital fractures and fractures of the orbital apex associated with decreasing vision represent surgical emergencies. Le Fort fractures involve disruption of the pterygoid plates from the posterior maxilla; any combination of Le Fort I, II, and III patterns can occur. © RSNA, 2006

https://pubs.rsna.org/doi/pdf/10.1148/rg.263045710

Diagnosis of Midface Fractures with CT: What the Surgeon

Midfacial fractures may often be associated with injuries to the orbit which may lead to notable dysfunction of the visual apparatus, if not detected early after injury. The purpose of this study is to evaluate the associated ophthalmic injuries in mid-face trauma and to emphasize the need for understanding the ophthalmic signs and symptoms by an attending maxillofacial surgeon. A total number of 60 clinically and radiographically proven subjects with midfacial fractures were considered in the study that underwent complete ophthalmological evaluation at initial presentation. Referral to ophthalmologist was considered to determine the exact nature of injury and its implications. Results by a maxillofacial surgeon and ophthalmologist were evaluated. In our study, a male predominance with a mean age of 32 years was observed, with the most common etiology being Road Traffic Accidents. Forty-two of the 60 patients exhibited sub-conjunctival hemorrhage accounting for 70 % of ocular injuries recorded. While 28 of the 60 patients displayed peri-orbital edema (53.3 %), 8 patients experienced diplopia (13.32 %) and 8 patients showed relative afferent pupillary defect (13.32 %). From our study, it becomes imperative that the maxillofacial surgeon should have a thorough knowledge of the various ophthalmic injuries that could occur in association with midfacial trauma in order to prevent visual complications to the patient. Understanding of the subtle injuries to the ocular apparatus which may be undiagnosed by a maxillofacial surgeon but have significant grave outcomes is essential.

/pdf/ophthalmological-evaluation-by-a-maxillofacial-surgeon-and-1iab83c82e.pdf

Ophthalmological Evaluation by a Maxillofacial Surgeon and an Ophthalmologist in Assessing the Damage to the Orbital Contents in Midfacial Fractures: A Prospective Study.

Background: Incidence of maxillofacial fractures is quite high worldwide. A very important aesthetic function is served by maxillofacial skeleton moreover the prominent position of maxillofacial skeleton makes it more susceptible to fracture. Methods: A prospective study was done to assess the main etiology and pattern of maxillofacial fractures of 60 patients who came to the emergency department of Sri Guru Ram Das Institute of Medical sciences and Research between January 2018 and June 2019. Results: Total number of patients taken for this study were 60. The number of male patients were 56 (93.33%) and number of female patients were 4 (6.66%) and male to female ratio was (14:1). The age range spanned from 11 years to 70 years with (mean age=37.30 years, SD=14.27). Primary etiologic factor for maxillofacial fractures was road traffic accidents (49, 81.66%), followed by fall (8, 13.33%), and assault accounted for (3, 5%). Total 229 fractures were present in 60 patients. Concerning the anatomical site of fractures, it was explored that most common site of fractures is orbit (59, 25.72%) followed by fractures of maxilla (55, 24%) and zygomatic complex (35, 15.28%). Infection was most common complication and was present in 2 (3.33%) of the patients during hospital stay. 21 (35%) of the patients had associated head injury and maximum patients 49 (81.66%) were treated by open reduction and internal fixation. Conclusions: It is concluded, that main etiology of maxillofacial trauma is road side accidents. Therefore, strict compliance of traffic rules can avoid such injuries.

/pdf/a-study-of-pattern-of-maxillofacial-fractures-and-its-4mxj3bczlc.pdf

A study of pattern of maxillofacial fractures and its complications

Aims The aim is to study the pattern of ocular injuries in midfacial trauma and to evaluate the overall incidence of ophthalmic injury of any severity following maxillofacial trauma. Methods and Materials The maxillofacial surgeon conducted routine facial examination of patients with midfacial fractures, which also included a detailed ophthalmologic examination of patients, at the time of initial presentation. These patients were then further evaluated by an ophthalmologist for thorough examination of the eye. Results The total number of recorded midface maxillofacial trauma cases was 181. Out of 181 patients, 161 had ocular injuries. Among 181 cases, 161 (88.95%) cases were due to road traffic accidents, which was the prime etiologic factor. Out of total 181 patients, 172 (95.03%) were males and 9 (4.97%) were females. The maximum number of cases were of zygomaticomaxillary complex fractures (44.75%) followed by nasal bone fractures (21.5%). Periorbital ecchymosis accounted for the maximum number of cases, amounting to 61.88%. Loss of vision or blindness was seen in eight (4.42%) patients. Conclusions The study stresses further on the importance of long-term and continuous data collection and record management of trauma patients, which may help health care providers with necessary information to develop treatment protocols and device measures for the prevention of complications.

A Clinical Study of the Evaluation and Assessment of the Etiology and Patterns of Ocular Injuries in Midfacial Trauma in a Tertiary Care Hospital.

The aim of the present study is to assess the reliability and accuracy of different 3-dimensional (3D) reconstruction algorithms in detecting undisplaced condylar, zygomatic arc, and orbital rim fractures based on cone-beam computed tomography data set. Twenty sheep heads were used in the present study. Sixty fractured and 60 nonfractured (control) zones were randomly allocated. Three groups consisting of nondisplaced fractures of condyle (CF, n = 20), orbital (OF, n = 20), and zygomatic arc (ZF, n = 20) were created by using a diamond cutting disc. Soft tissues were only dissected and no fractures were generated in the control group (n = 60). The 3D reconstructions were created by using multiplanar reconstruction (MPR), surface rendering (SR), volume rendering (VR), and maximum intensity projection (MIP) algorithms. Final 3D models were examined in Osirix software (Pixmeo SARL, Bernex, Switzerland) by 6 observers. Diagnostic accuracies of each algorithm were statistically compared by receiver operating characteristics (ROC) and area under the ROC curves (AUCs). For the detection of CF, AUC for VR algorithm was found to be statistically larger than that of MIP while AUCs for VR and MIP were larger than those of MPR and SR for OF detection. For the detection of ZF, AUCs for MPR and VR were significantly larger than those of MIP and SR (P < 0.05 for each). Within the limitations of this experimental study, it can be concluded that for maxillofacial surgeons, it is more likely to detect condylar, orbital, and zygomatic fractures by using VR algorithm in 3D reconstruction.

Direct Three-Dimensional Diagnosis of Ex Vivo Facial Fractures.

Purpose. To characterize cases of orbital fractures diagnosed by computed tomography (CT) during a time period of one year at our Imaging Department. Materials and Methods. A cross-sectional descriptive study was performed. All cases of orbital fracture diagnosed during a period of one year (from June 2011 to June 2012) were identified. The analyzed variables were: patient age and sex, mechanism of fracture production, fracture location, and need for surgical management. EpiDat 3.1 was used for the data statistics processing. Results. Orbital fractures were diagnosed in 25 of the 167 patients who underwent orbital computed tomography during that period: 5 female (20%) and 20 male (80%). The mean age of the injured patients was 31 years (range 1 to 63 years). The fracture mechanisms were: falls (32%), physical aggression (44%), car accidents (8%), and other causes (16%). Fifteen cases (60%) required surgical management. As regards fracture distribution, 10 of them (40%) were isolated (just one orbital wall involved), while 15 (60%) were combined (2 or more orbital walls involved). Right orbital fractures were found in 11 cases (44%), while left and bilateral fracture locations were detected in 12 (48%) and 2 cases (8%), respectively. Conclusion. The most common types of isolated orbital fractures found in our study were those of the orbital floor and the medial orbital wall, which could be associated with their known anatomical weakness. Mean age and gender distribution of lesions were consistent with those reported by other studies.

/pdf/classification-and-epidemiology-of-orbital-fractures-432ufxojav.pdf

Classification and epidemiology of orbital fractures diagnosed by computed tomography

Compromiso pulmonar difuso en las enfermedades reumáticas: hallazgos tomográficos

<h3>Introduction</h3> CT angiography (CTA), the modality of choice for detection of intracranial aneurysms (IA), is widely available at all care levels. Implementing deep learning algorithms (DLA) in the radiologists’ workflow could result in higher detection rates, particularly in smaller centers. We present results of multicenter pre-clinical experience with a new IA detection DLA. <h3>Methods</h3> A DLA was developed at Site 1 to predict the existence and locations of IAs &gt;2 mm in 3D head CTA volumes. It localizes IAs using an improved 3D UNet to regress the bounding boxes of suspicious locations. IA presence is confirmed by a multi-resolution 3D DenseNet at each suspicious location. The model was trained on 436 studies and tested on 696 studies from site 1. To validate robustness against protocol variability, it was retrospectively tested on 337 volumes (149 positives, 188 negatives) from 4 additional sites with various types of scanners. A neuroradiologist/trained fellow from each site annotated bounding boxes around the IAs with 3DSlicer. The model’s performance was assessed by comparing its predicted aneurysm locations to the annotated boxes. <h3>Results</h3> The model achieved a lesion-level sensitivity of 0.72 (95% CI: 0.66 - 0.75) with 1.4 false positives per volume (FPPV, 95% CI: 1.22 - 1.57). Sensitivity ranged 0.84 (1.72 FPPV) - 0.67 (1.40 FPPV) amongst 5 sites. Performance variation was secondary to testing on images from scanners the model had not been trained on (unseen). Removing unseen scanners, the model achieved sensitivity of 0.77 (95% CI: 0.68 - 0.84) with 1.51 FPPV (95% CI: 1.24 - 1.82). Patient-level area under curves (AUCs) on the external sites were comparable to that of site 1 dataset, which was 0.88 (95% CI: 0.84 - 0.92). The model performed better in the detection of internal carotid and anterior communicating artery IAs &gt; 3 mm. <h3>Conclusions</h3> This DLA for IA detection showed robust performance in detecting IAs &gt; 3 mm. DLAs may reliably help detection of IAs on CTA, particularly in the community practices less familiar with intracranial vascular imaging. Different scanners can lead to performance variability. This can be avoided by training with data from different scanners. <h3>Disclosures</h3> <b>D. Wu:</b> 1; C; National Institute of Health. <b>E. Orru’:</b> None. <b>S. Ferraciolli:</b> None. <b>A. Ashok:</b> 1; C; NIHR Academic Clinical Fellowship. <b>A. Sorby-Adams:</b> None. <b>M. Guindy:</b> None. <b>D. Montes:</b> None. <b>A. Medina:</b> None. <b>G. Bianco:</b> None. <b>J. Kaggie:</b> 1; C; NIHR Cambridge BRC. <b>D. Rabina:</b> None. <b>O. Ashush:</b> None. <b>X. Han:</b> None. <b>Y. Baror:</b> None. <b>M. Patel:</b> 4; C; Rhino HealthTech Inc. <b>I. Dayan:</b> 4; C; Rhino HealthTech Inc.. <b>J. Romero:</b> None. <b>R. González:</b> 1; C; National Institute of Health. 2; C; MR Access, Inc.. 4; C; MR Access, Inc.. <b>C. Wald:</b> None. <b>F. Kitamura:</b> 2; C; MD.ai, GE Healthcare. <b>P. Kuriki:</b> None. <b>T. Matys:</b> 1; C; NIHR Cambridge BRC. 2; C; NHS. <b>Q. Li:</b> 1; C; National Institute of Health. 

/pdf/e-107-multi-center-study-of-a-deep-learning-model-for-eqbin8mv.pdf

Ana Josefina Medina

Papers

Classification and epidemiology of orbital fractures diagnosed by computed tomography

Compromiso pulmonar difuso en las enfermedades reumáticas: hallazgos tomográficos

E-107 Multi-center study of a deep learning model for intracranial aneurysm detection in computed tomography angiography

En las enfermedades intersticiales difusas, ¿todos los quistes son realmente quistes?*