New diagnostic techniques for the evaluation of orbital trauma

Midfacial trauma can produce fractures and soft tissue injuries and can embed foreign bodies within the eye, orbit, and brain. A careful history and ocular examination are fundamental to the evaluation of any patient who has suffered orbital injuries. Damage to the paranasal sinuses and the nasolacrimal system should be considered as a possible consequence of trauma to the orbit. Fractures are best evaluated by conventional roentgenograms with linear or hypocycloidal tomography. Bony fragments can be well visualized by xeroradiography. Positive contrast orbitography may be hazardous and has been replaced by noninvasive diagnostic techniques. Computerized tomography is useful in localizing soft tissue injuries and foreign bodies. Damage within the eye may be evaluated by ultrasonography. Cerebrospinal fluid leaks can be diagnosed by radionuclide cisternography, using nasal sample counting or scintiphotographic imaging. Carotid-cavernous sinus fistulas and other vascular abnormalities may be investigated by radionuclide angiography at minimal risk to the patient.