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Management of Zygomaticomaxillary Complex Fractures Utilizing Intraoperative 3-Dimensional Imaging: The ZYGOMAS
Karl Cuddy1, Eric J Dierks2, Allen Cheng3
1Assistant Professor, Director of Education and Maxillofacial Trauma, Division of Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario.
Summary
Intraoperative CT scans aid in managing zygomaticomaxillary complex (ZMC) fractures, especially those with orbital reconstruction or multiple displaced axes. This technology improves decision-making and reduces revision rates in complex facial trauma surgery.
Area of Science:
- Craniomaxillofacial surgery
- Trauma surgery
- Medical imaging
Background:
- Technology is increasingly used for complex craniomaxillofacial injury management.
- Limited data exist on intraoperative CT/3-Dimensional imaging's impact on zygomaticomaxillary complex (ZMC) fracture treatment decisions.
Purpose of the Study:
- To characterize intraoperative CT scanner use in ZMC fracture surgery.
- To analyze the impact of intraoperative CT on fracture management.
- To propose an algorithm for guiding intraoperative 3-Dimensional imaging in ZMC fracture surgery.
Main Methods:
- Retrospective case series of 71 patients undergoing orbitozygomatic trauma surgery with intraoperative CT.
- Evaluation of preoperative CT for fracture characteristics: displaced sutures, adjacent fractures, comminution, and displacement.
- Analysis of intraoperative CT utilization and its impact on surgical decisions.
Main Results:
- A 23.9% (17/71) CT-directed revision rate was observed.
- Increased likelihood of revision for fractures with adjacent fractures requiring fixation.
- Higher revision rates noted for fractures with ≥ 2 axes displaced ≥ 5 mm.
- The ZYGOMAS algorithm was developed based on these findings.
Conclusions:
- Intraoperative CT/3-Dimensional imaging should be used for ZMC fractures requiring orbital floor reconstruction.
- Utilization is recommended when adjacent fractures need fixation.
- Consideration is advised for fractures with ≥ 2 axes displaced ≥ 5 mm.
