Role of Intraoperative Ultrasonography in the Management of Zygomatic Fractures- A Systematic Review

Ultrasonography (USG) is a radiation-free imaging modality that provides real-time visualization of internal structures. This systematic review evaluates the role of USG in the management of zygomatic fractures.

A systematic review was conducted following PRISMA guidelines. The literature searches in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library (inception to October 2024) identified studies using intraoperative USG for zygomatic fracture reduction and fixation. Data on study characteristics, USG protocols, outcomes, and challenges were extracted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool.

Twelve studies (246 patients) were analyzed. USG was mainly used for fracture reduction of zygomaticomaxillary complex (ZMC) (N = 7) and isolated zygomatic arch(N = 5), with some applications in reduction and fixation. Linear probes with frequencies between 5 and 12 MHz were commonly used. Challenges included limited visibility due to patient-related factors (swelling, tissue edema), USG-related limitations (low resolution, incorrect transducer frequency) and surgeon-related factors (learning curve, over-reduction errors). Post-operative CT/CBCT served as a reference to confirm USG's accuracy.

USG shows potential as intraoperative imaging for reduction and fixation of ZMC fracture despite challenges such as limited visualization in cases of soft tissue swelling or deeply located fracture sites.

The online version contains supplementary material available at 10.1007/s12663-025-02775-y.