Assessment of the Relationship Between the Risk for Orbital Blowout Fracture After Trauma and Ethmoidal Sinus Morphometry Using the 3D Slicer Application

Background and objectives: The purpose of this study was to investigate whether high ethmoid sinus volume (ESV) constitutes a risk factor for the formation of orbital blowout fractures (OBF) after craniofacial trauma and whether it affects the fracture pattern. Materials and Methods: This is a retrospective case-control study involving subjects over 15 years of age who presented to the emergency department with craniofacial trauma. The case group included subjects with OBF, while the control group included subjects without any facial fractures. The case group was divided into subgroups according to the fracture location. We performed volumetric measurements on computed tomography images of the ethmoid sinuses of subjects in the case and control groups using the fully automated 3D Slicer application. The mean ESV values of the groups were compared using the necessary statistical methods. P-values below 0.05 were considered significant. Results: The case group consisted of 108 (median age: 41.5 years; 76 males, 69%), and the control group consisted of 122 (median age: 38 years; 84 males, 69%) subjects. OBFs were more frequent in males (69%), most commonly detected in the orbital floor (68.2%), and were bilateral in two (1.8%) subjects. The mean ESV in the case group (3.91 ± 1.39 cm³) was significantly higher than that in the control group (2.82 ± 0.94 cm³) (p< 0.001). Unlike the cases with medial wall fractures and those with orbital floor fractures, there was no significant difference in mean ESV between the cases with medial wall and orbital floor fractures and the control group (p= 0.562). Conclusions: A large ethmoid sinus not only increases the risk of orbital blowout fracture but also has an impact on the fracture pattern. Based on the data obtained from our study, we identified a large ethmoid sinus as a predictive risk factor for orbital blowout fracture.