The Utility of Postoperative Computed Tomography Imaging Following Isolated Orbital Blowout Fracture Repair

Sara E Francomacaro; Jana A Bregman; Kalpesh T Vakharia; Francis L Grumbine

doi:10.1177/1943387520922048

The Utility of Postoperative Computed Tomography Imaging Following Isolated Orbital Blowout Fracture Repair

Craniomaxillofac Trauma Reconstr. 2020 Sep;13(3):198-204. doi: 10.1177/1943387520922048. Epub 2020 Apr 30.

Authors

Sara E Francomacaro¹, Jana A Bregman¹, Kalpesh T Vakharia², Francis L Grumbine¹

Affiliations

¹ Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, MD, USA.
² Department of Otorhinolaryngology, University of Maryland Medical Center, Baltimore, MD, USA.

Abstract

Purpose: To determine the clinical utility of computed tomography (CT) imaging following isolated orbital blowout fracture (OBF) repair.

Methods: Single-center retrospective review of adult patients undergoing surgical repair of isolated OBFs between November 2008 and August 2016 who received postoperative CT scans. Preoperative and postoperative examination data, postoperative imaging reads, postoperative courses, and any reoperation documentation were collected from electronic medical records. Postoperative imaging findings were categorized as major, indeterminate, or minor by predicted impact on clinical management. Major findings indicated a need for reoperation, indeterminate a potential reoperation, and minor no reoperation.

Results: Fifty-two cases met inclusion criteria: 94.2% (n = 49) of postoperative scans included minor findings, 34.6% (n = 18) indeterminate findings, and 19.2% (n = 10) major findings. Three patients returned to the operating room (OR) for surgical revision. All 3 had a significant and concerning change on postoperative examination. Only 1 also had a major finding on postoperative imaging. The remaining 49 patients had benign postoperative examinations, despite 9 (17.3%) with major imaging findings who did not undergo reoperation.

Conclusions: In the majority of OBF repairs, postoperative CT scan findings were not predictive of a need to return to the OR for revision. Reoperation was instead largely prompted by concerning changes in the postoperative clinical examination. Our findings suggest that postoperative imaging in the absence of clinical concern should not be included in the surgical management of isolated OBFs. Instead, targeted imaging will help reduce radiation exposure and health-care costs without sacrificing patient care.

Keywords: computed tomography; isolated orbital blowout fracture; orbital blowout fracture repair; postoperative; postoperative imaging; routine postoperative imaging.