Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury - Is It Safe? Radiological...

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Radiology

Background:

• Maxillofacial procedures often require specific patient positioning.
• The effects of these positions on the cervical spine (C-spine) are not fully understood.
• Assessing C-spine movement during simulated surgical positions is vital for patient safety.

Purpose of the Study:

• To investigate the impact of simulated intraoperative positions on the cervical spine.
• To identify areas of maximal and minimal movement within the C-spine during common maxillofacial procedure positions.
• To inform safe patient handling during combined maxillofacial and C-spine injuries.

Main Methods:

• Observational study utilizing magnetic resonance imaging (MRI).
• Assessed C-spine effects in neutral, extended (tracheostomy), and laterally rotated (mandibular condyle) positions.
• Evaluated movement in sagittal and rotational planes across C-spine segments.

Main Results:

• Tracheostomy position showed maximal sagittal plane movement at cervico-occipital and cervico-thoracic junctions.
• Mandibular condyle position demonstrated maximal C-spine movement above C4, especially at atlanto-occipital and atlanto-axial joints.
• Minimal movement was observed at specific lower C-spine levels (C2/C3, C5/C6, C6/C7) in the extended position.

Conclusions:

• Neck extension may be safe for certain stable C-spine injuries (e.g., odontoid peg, C5-C7 fractures).
• Head rotation appears safer for fractures below C4 and certain vertebral/laminar fractures.
• Collaboration between maxillofacial and neurosurgical teams is essential for managing combined injuries.