Ultrasonography in orbital floor fractures: An alternative to computed tomography?

Background: Plain radiography of the paranasal sinuses (Water's view) may fail to demonstrate typical signs of orbital floor fractures. To resolve questionable cases, computed tomography (CI) is performed. B-mode ultrasonography (US) is investigated concerning its reliability and as a possible alternative to CT. The replacement of standard radiological techniques in primary evaluation will be discussed. Methods: A skull was used to assess the visualization of the bony floor in the ultrasound-technique. Fifteen patients with suspected fractures of the orbital floor were investigated with plain radiographs, ultrasound of both orbits in dosed-eyelid technique, and CT scans. The findings were compared, Results: Thirteen patients were found to have apparent fractures in CT scans. These fractures were also diagnosed on ultrasound. In three patients, ultrasonographic localization was unprecise. These fractures were located behind the lower orbital rim or far posteriorly. Plain radiographs showed positive Fracture signs only in five patients, Localization was not possible, The application of the ultrasound probe was well tolerated. Conclusions: B-mode ultrasonography is a valuable and inexpensive technique to visualize orbital floor fractures, it should be employed in primary evaluation in patients with suspected isolated orbital floor fractures prior to taking plain radiographs of the paranasal sinuses. Computed tomography should be used in suspected complex fractures and questionable orbital fractures.