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

## TL;DR

This study found that larger ethmoid sinuses increase the risk of orbital blowout fractures after facial trauma and influence the fracture pattern.

## Contribution

The study demonstrates a novel association between ethmoid sinus volume and orbital blowout fracture risk and pattern.

## Key findings

- Higher ethmoid sinus volume significantly increases the risk of orbital blowout fractures.
- Orbital blowout fractures are more common in males and frequently occur in the orbital floor.
- Fracture pattern is influenced by ethmoid sinus volume, with no significant difference in volume for medial wall fractures.

## Abstract

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 (OBFs) after craniofacial trauma and whether it affects the fracture pattern. Materials and Methods: This retrospective case–control study included patients aged ≥15 years who presented with craniofacial trauma to the emergency department of a Turkish university hospital between 1 October 2022 and 1 September 2023. The predictor variable was the presence of OBF (yes/no). The primary outcome variable was mean ESV, measured on computed tomography using the fully automated 3D Slicer software. Statistical analyses were performed with a significance level set at p < 0.05. Results: The case group consisted of 108 (median age: 41.5 years; 76 males, 70.38%), and the control group consisted of 122 (median age: 38 years; 84 males, 68.85%) 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 demonstrated a significant association between ethmoid sinus volume and the incidence of orbital blowout fracture.