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Five-Year Experience With Routine Use of Intraoperative Cone-Beam Computed Tomography in Zygomaticomaxillary Complex
Dominique Korner1, Daphne Schönegg2, Daniel Wiedemeier3
1Doctoral Candidate, Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland.
Summary
Intraoperative cone-beam computed tomography (CBCT) for zygomaticomaxillary complex (ZMC) fractures revealed a high revision rate. CBCT aids in identifying malpositions and candidates for orbital reconstruction, improving surgical precision.
Area of Science:
- Maxillofacial Surgery
- Radiology
- Orthognathic Surgery
Background:
- Intraoperative cone-beam computed tomography (CBCT) assists in reconstructing complex 3-dimensional anatomy during zygomaticomaxillary complex (ZMC) fracture repair.
- ZMC fractures often present complex anatomical challenges requiring precise surgical intervention.
Purpose of the Study:
- To quantify malposition rates following ZMC fracture reduction using intraoperative CBCT.
- To determine intraoperative revision rates in ZMC fracture repair when utilizing intraoperative CBCT.
Main Methods:
- A retrospective case series of 337 patients with ZMC fractures treated with intraoperative CBCT from 2015-2019.
- Statistical analyses included correlation, chi-squared, and Fisher's exact tests (P < .05).
Main Results:
- Malposition after ZMC reduction was observed in 45.7% of patients, commonly involving caudal displacement, underprojection, and inward rotation.
- Intraoperative revisions were performed in 44.5% of cases, including 31.2% for malposition and 9.5% for orbital floor reconstruction.
- No secondary surgeries were needed for ZMC malpositions, though 25 secondary orbital floor reconstructions were excluded.
Conclusions:
- The high intraoperative revision rate (44.5%) highlights the complexity of ZMC fracture surgery.
- Clinical assessment of the latero-orbital rim is crucial for detecting caudal displacement.
- Intraoperative CBCT is valuable for identifying patients needing primary orbital floor reconstruction, enhancing quality control and outcomes.
