How reliable is the visual appraisal of a surgeon for diagnosing orbital fractures?
OBJECTIVE
The aim of this study was to evaluate the usefulness of intra-operative visualisation, endoscopic assistance, and CT measurements for estimating the orbital fracture size and complexity.


METHODS
Ten human cadaver heads were subjected to thin-slice computed tomography (CT). Standardised fractures were created using piezoelectric surgery in accordance with the Jaquiéry classification system. Four surgeons and one anatomist used six different observation methods to visualise and describe the orbital defects.


RESULTS
The intraclass correlation coefficients (ICCs) for the fracture length measurements were relatively low for all observation methods (range, 0.666-0.883). CT measurements of width showed high consistency (ICC, 0.910). The surface area of the defect was highly overestimated by all methods (range, 121-184%). None of the observers was able to accurately estimate the length or width of 95% of the defects within an error range of ±0.75 cm.


CONCLUSIONS
CT measurements are the most consistent and accurate tool for estimating the critical size of orbital factures. In daily practice, a measurement tool in a DICOM viewer could be used, although software packages that allow manual adjustments are advisable. Direct intraoperative visualisation and surgeon experience are of limited value in the estimation of fracture size and complexity, and endoscopy provides no additional advantages.
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands. Electronic address: L.Dubois@amc.uva.nl.
Leander
L
Dubois
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands.
Jesper
J
Jansen
3D Laboratory Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands.
Ruud
R
Schreurs
Department of Anatomy, Embryology and Physiology (Head: Prof. Dr. R. Oostra), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands.
Petra E M
PE
Habets
Department of Otolaryngology (Head: Prof. Dr. W. Fokkens), Academic Medical Centre of Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands.
Susanne M
SM
Reinartz
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands.
Peter J J
PJ
Gooris
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Academic Centre for Dentistry (ACTA), Meibergdreef 9, 1105 AZ, Amsterdam ZO, The Netherlands.
Alfred G
AG
Becking
D002102:Cadaver; D004724:Endoscopy; D006801:Humans; D015588:Observer Variation; D009917:Orbital Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D066231:Surgeons; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
Classification; Computed tomography; Computer-assisted surgery; Diagnostics; Endoscope; Orbital fracture