Assessment of zygomatico-orbital complex fractures using ultrasonography

Twenty-two patients were referred to the maxillofacial surgical unit for assessment and management of suspected fractures of the zygomatico-orbital complex. In each case, both routine plain radiographic and ultrasound examinations were made. The aim of the study was to investigate the sensitivity and reliability of ultrasound to detect such fractures. Imaging with ultrasound was carried out at five areas: the infraorbital margin; lateral wall of the maxillary sinus; zygomatic arch; frontozygomatic process; and orbital floor. Both radiographic and ultrasound findings were correlated with the findings at operation. An overall agreement of 85% between radiographs and ultrasound scans was found. Ultrasound imaging was most reliable at the lateral wall of the maxillary sinus, where the sensitivity was 94% and specificity 100%. The positive predictive value at this area was 100% compared with radiographic findings. We conclude that ultrasound is a useful tool in imaging facial trauma as an initial investigation, and can help to reduce the total number of radiographs required for the diagnosis of fractures of the zygomatico-orbital complex.