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Clinical Utility of Postoperative Computed Tomography Imaging in Orbital Floor Fracture Management

Sharma, Ajay N. BS*; Tiourin, Ekaterina BS*; Banyard, Derek A. MD, MBA, MS; Sharma, Shonit N. BS; Ng, Wendy K. Y. MD, FRCSC

doi: 10.1097/SAP.0000000000001777
Head and Neck Surgery

Background Surgical repair of orbital floor fractures aims to improve visual function and appearance. Postoperative care often involves computed tomography (CT) imaging in addition to physical examination. It has yet to be investigated whether postoperative CT imaging influences treatment of orbital floor fractures.

Methods A retrospective chart review was conducted for all patients who underwent orbital floor fracture repair at University of California, Irvine, from 2008 to 2017. Demographics, injury characteristics, and presurgical and postsurgical management were retrospectively extracted for 217 cases. Patients who experienced a change of care following postoperative CT (n = 6) were compared with the entire patient cohort.

Results Postoperative CT imaging influenced orbital floor fracture management in 6 patients (7.2% of patients with imaging). The positive predictive value of a postoperative CT scan was 10.3%, compared with 17.6% for a physical examination. An estimated $2013.76 was spent to obtain a postoperative CT scan that revealed 1 additional patient who needed reoperation (number needed to treat = 14). A multivariate regression model demonstrated no association between postoperative CT scans and change in management (P = 0.995).

Conclusions In this patient cohort, postoperative CT imaging and its associated costs did not significantly benefit management of orbital floor fracture repair. Careful clinical physical examination should be emphasized over postoperative CT imaging to reliably determine the necessity for reoperation in orbital floor fracture management.

From the *School of Medicine and

Department of Plastic Surgery, University of California, Irvine; and

Department of Biomedical Engineering, University of California, Davis, CA.

Received August 15, 2018, and accepted for publication, after revision October 26, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Wendy K. Y. Ng, MD, FRCSC, Department of Plastics Surgery, 200 S Manchester Ave, Suite 650, Orange, CA 92868. E-mail:

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Online date: January 10, 2019

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