J Korean Assoc Oral Maxillofac Surg.  2021 Oct;47(5):382-387. 10.5125/jkaoms.2021.47.5.382.

Three-dimensional intraoperative computed tomography imaging for zygomatic fracture repair

Affiliations
  • 1Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,
  • 2Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract


Objectives
Zygomatic complex (ZMC) fractures comprise up to 40% of all facial fractures. Misaligned bone fragments and misplaced fixation hardware traditionally detected postoperatively on plain radiographs of the skull might require re-operation. The intraoperative O-Arm (Medtronic, USA) is a three-dimensional (3D) computed tomographic imaging system.
Materials and Methods
This retrospective single-center study evaluated the utility of O-Arm scanning during corrective surgeries for ZMC and zygomatic arch (ZA) fractures from 2018 to 2020. Three females and 16 males (mean age, 31.52 years; range, 22-48 years) were included. Fracture instability (n=6) and facial deformity (n=15) were the most frequent indications for intraoperative 3D O-Arm scan.
Results
The images demonstrated that all fracture lines were properly reduced and fixed. Another scan performed at the end of the fixation or reduction stage, however, revealed suboptimal results in five of the 19 cases, and further reduction and fixation of the fracture lines were required.
Conclusion
Implementation of an intraoperative O-Arm system in ZMC and ZA fracture surgeries assists in obtaining predictable and accurate results and obviates the need for revision surgeries. The device should be considered for precise operations such as ZMC fracture repairs.

Keyword

Zygomatic fractures; Maxillofacial injury; Maxillofacial procedure; X-ray computed tomography; CT X ray

Figure

  • Fig. 1 A composite figure presenting two clinical cases. Case No. 1: a preoperative computed tomographic scan demonstrating a right zygomatic arch fracture (A) followed by an intraoperative O-Arm scan that demonstrates an adequate reduction of the zygomatic arch fracture (B). Case No. 2: an insufficient reduction of a left zygomatic complex (ZMC) fracture as demonstrated in an intraoperative O-Arm scan (C), and a second intraoperative O-Arm scan following the correction of the reduction and fixation of the left ZMC fracture lines (D).

  • Fig. 2 A composite figure presenting another case: a preoperative three-dimensional (3D) reconstruction computed tomographic scan demonstrates a left zygomatic complex fracture (A, B) followed by an intraoperative O-Arm scan that demonstrates a proper reduction and fixation of the zygomatic complex fracture (C), and a 3D reconstruction of the same intraoperative O-Arm scan presenting a good clinical result (D).


Reference

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