3D cephalometric analysis of orbital aperture dimensions and shapes: a single-center cross-sectional study

Orbital morphometric parameters are of clinical importance in cases of traumatic injuries, congenital anomalies, tumors, and other pathological conditions. The morphology of the orbital apertures demonstrates both individual and population variability. Despite the presence of several publications, studies of cephalometric orbital parameters based on three-dimensional (3D) computed tomography (CT) remain limited.

Objective. To assess the dimensions and shapes of orbital apertures using 3D cephalometric analysis.

Methods. A single-center cross-sectional study was conducted, including CT data of adult patients. Cephalometric measurements of linear and angular orbital parameters were performed; facial and orbital indices were calculated; the shapes of orbital apertures, orbital cavity, and supraorbital margin were determined. Automated image analysis was implemented using artificial intelligence algorithms. Statistical processing was performed using descriptive and comparative methods at a significance level of p<0.05.

Results. The study included 300 patients, comprising 150 males and 150 females aged 18–45 years (mean age 31.8 ± 7.6 years; no significant sex differences in age, p>0.05). No statistically significant sex-related differences in linear orbital dimensions were observed. Facial parameters were significantly greater in males (p<0.001). The left orbital index was higher in males (p=0.037), although the difference lost significance after multiple comparison adjustment. Interorbital distance was greater in males (p<0.001). The predominant orbital type was megaseme (72–81%), and the most frequent aperture shape was rectangular. Orbital inclination and zygomatico-orbito-maxillary complex angulation showed no sexual dimorphism. No correlation was found between the facial and orbital indices.

 Conclusion. This study presents a comprehensive 3D cephalometric analysis of orbital aperture dimensions and shapes. The findings demonstrate high stability of orbital morphometric characteristics with minimal sexual dimorphism, establish regional normative reference values, and highlight clinical significance. The results are applicable for planning reconstructive procedures and may also be used in forensic examinations and anthropological research.

1. Cornelius C.P., Probst F., Metzger M.C., Gooris P.J.J. Anatomy of the orbits: skeletal features and some notes on the periorbital lining. Atlas Oral Maxillofac Surg Clin North Am. 2021;29(1):1–18. doi: 10.1016/j.cxom.2020.10.001.

2. Dutton J.J. Osteology of the orbit. In: Dutton J.J., ed. Atlas of Clinical and Surgical Orbital Anatomy. 3rd ed. Amsterdam: Elsevier; 2025:15–30. doi: 10.1016/B978-0443-10942-3.00011-5.

3. Hanratty J., Perry M. The cheek and orbit: Part I. In: Perry M., ed. Diseases and Injuries to the Head, Face and Neck. Cham: Springer; 2021:757–789. doi: 10.1007/9783-030-53099-0_15.

4. Chodankar N.U., Dhupar V., Vijay V., Fernandes N. Surgical anatomy in orbital fractures: a surgeon’s perspective. J Maxillofac Oral Surg. 2024;23(3):462–474. doi: 10.1007/s12663-023-02086-0.

5. Gooris P.J.J., Mourits M.P., Bergsma J.E., eds. Surgery in and around the Orbit: CrossRoads. Cham: Springer; 2023. doi: 10.1007/978-3-031-40697-3.

6. Roccia F., Iocca O., Sobrero F., et al. World Oral and Maxillofacial Trauma (WORMAT) project: a multicenter prospective analysis of epidemiology and patterns of maxillofacial trauma around the world. J Stomatol Oral Maxillofac Surg. 2022;123(6):e849–e857. doi: 10.1016/j.jormas.2022.05.004.

7. Belchenko V.A., Chantyr I.V. Retrospektivny analiz khirurgicheskogo lecheniya vzroslykh patsientov s travmami i posttravmaticheskimi deformatsiyami srednei zony litsevogo skeleta [Retrospective analysis of surgical treatment of adult patients with midface trauma and post-traumatic deformities]. Stomatologiya dlya vsekh / International Dental Review. 2024;107(2):4–11. Russian. doi: 10.35556/ idr-2024-2(107)4-11.

8. Chen Y., Weber A., Chen C. Evidence-based medicine for midface/orbit/upper facial fracture repair. Facial Plast Surg. 2023;39(3):253–265. doi: 10.1055/s-0043-1764290.

9. Khan Z., Nadeem G., Khan H., Khair A.M.B. An anatomical study of orbital dimensions and its utility in orbital reconstructive surgery. Onkol Radioter. 2021;15(3):1–9. Accessed February 27, 2025. Available from: https://www.oncologyradiotherapy.com/articles/an-anatomical-study-of-orbital-dimensions-and-its-utility-in-orbital-reconstructive-surgery.pdf.

10. Triantafyllou G., Botis G.G., Piagkou M., et al. Sex estimation through orbital measurements: a machine learning approach for forensic science. Diagnostics (Basel). 2024;14(24):2773. doi: 10.3390/diagnostics14242773.

11. Yao K., Xie Y., Xia L., Wei S., Yu W., Shen G. Reliability of three-dimensional landmark-based craniomaxillofacial and airway cephalometric analysis. Diagnostics (Basel). 2023;13(14):2360. doi: 10.3390/diagnostics13142360.

12. Patra A., Singla R.K., Mathur M., et al. Morphological and morphometric analysis of the orbital aperture and their correlation with age and gender: a retrospective digital radiographic study. Cureus. 2021;13(9):e17739. doi: 10.7759/cureus.17739.

13. Kanjani V., Rani A., Kanjani D. Morphometric analysis of the orbital aperture in North Indian population: a retrospective digital forensic study. Int J Appl Basic Med Res. 2019;9(2):85–89. doi: 10.4103/ijabmr.IJABMR_404_18.

14. Mani S., Ahamed Y.S., Ambiga P., Ramalingam V., Sivaraman G., Balan N. Evaluation of orbital morphometry using 3D computed tomographic images in biological sex determination: a retrospective study. J Indian Acad Oral Med Radiol. 2020;32(4):390–395. doi: 10.4103/jiaomr.jiaomr_152_20.

15. Bhatti M.O.A., Parrey M.U.R., Ali M.I., Shoro A.R., Alenazi A.A., Alruwaili R.A. Gender-based morphometric analysis of the human orbital aperture profile using 3D reconstruction computed tomography: a cross-sectional retrospective study. J Clin Diagn Res. 2025;19(1):NC09–NC11. doi: 10.7860/JCDR/2025/76040.20509.

16. Davydov D.V., Pavlova O.Yu., Serova N.S. Novye metody analiza dannykh KT u patsientov s posttravmaticheskimi defektami i deformatsiyami srednei zony litsa [New methods for CT data analysis in patients with post-traumatic defects and deformations of the midface]. Plast khir est med. 2020;(2):46–52. Russian. doi: 10.17116/plast.hirurgia202002146.

17. Jeon A., Lee U.Y., Kwak D.S., Lee J.H., Ra H., Han S.H. Aging of the bony orbit in East Asians: a three-dimensional computed tomographic study. Surg Radiol Anat. 2020;42(5):617–626. doi:10.1007/s00276-019-02410-9.

18. Ominde B.S., Iju W., Igbigbi P.S. Retrospective CT study on orbital dimensions and their role in sex determination. Acta Scientifi Anatomy. 2022;1(4):2–12. Accessed February 27, 2025. Available from: https://actascientific.com/ASAT/pdf/ASAT-01-0021.pdf.

19. Kurbatova O.L., Gracheva A.S., Pobedonostseva E.Yu., Udina I.G. Genetiko-demograficheskie parametry naseleniya Moskvy. Migratsionnye protsessy [Genetic and demographic parameters of the Moscow population. Migration processes]. Genetika. 2021;57(12):1438–1449. Russian. doi: 10.31857/S0016675821120080.

20. El-Farouny R., Hassanien S., Azab R. Morphometric evaluation of piriform and orbital aperture in sex discrimination by using computed tomography in Egyptian population. Egypt J Forensic Sci Appl Toxicol. 2021;21(1):1–12. doi: 10.21608/ejfsat.2021.54250.1182.

21. Lee M., Yoo J., Lee H. Objective analysis of orbital rim fracture CT images using curve and area measurement. Sci Rep. 2024;14:27925. doi: 10.1038/s41598-02476818-8.

22. Prévost A., Muller S., Lauwers F., Heuzé Y. Quantification of global orbital shape variation. Clin Anat. 2023;36(8):1066–1074. doi: 10.1002/ca.24007.