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-dimensional (3D) computed tomography (CT) in the assessment of these fractures remains unclear. To clarify the diagnostic value of 3D CT, this retrospective analysis compares statistically the accuracy of two-dimensional (2D) CT against 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 serving 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 either modality alone. Although 2D CT was significantly superior (p < 0.05) for inspection of the medial orbital wall, 3D CT offered significantly greater diagnostic accuracy (p < 0.05) along the medial maxillary buttress, particularly at the piriform aperture. 3D CT clarified spatially several unusual NOE injuries that were indiscernible with 2D CT alone. We recommend the combination of 3D CT with 2D CT for serious NOE injuries, particularly those involving displacement of the NOE complex or associated with other major midfacial fractures.