Intraoperative CT: A Teaching Tool for the Management of Complex Facial Fracture Fixation in Surgical Training

Ibrahim, Ahmed M.S.; Rabie, Ahmed; Lee, Bernard T.; Lin, Samuel J.

doi:10.1016/j.jsurg.2011.05.013

Cited by 8 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…more-experienced surgeons could be more selective in its use. The educational value of intraoperative imaging has been previously documented 11 and fulfills an educational objective by providing timely and specific feedback to both the trainee and primary surgeons. In the current landscape of work-hour restrictions and less resident continuity of care, the immediate feedback may be instrumental in shortening the learning curve for proficiency in maxillofacial reconstruction.…”

mentioning

confidence: 99%

Use of Intraoperative Computed Tomography for Maxillofacial Reconstructive Surgery

Shaye

Tollefson

Strong

2015

JAMA Facial Plast Surg

View full text Add to dashboard Cite

IMPORTANCE Intraoperative computed tomography (CT) provides surgeons with real-time feedback during maxillofacial trauma and reconstructive surgery, which can affect intraoperative decision making. OBJECTIVES To evaluate the time needed to perform intraoperative CT scans during maxillofacial surgery, determine any trend toward shorter total scan times as experience is gained with the technique, and identify the characteristics of cases that required intraoperative revision based on the results of intraoperative CT scanning. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was completed for all maxillofacial reconstruction procedures that used intraoperative CT between January 1, 2012, and March 31, 2014. INTERVENTIONS Patients were cared for by the routine practice pattern of the authors. Intraoperative CT scans were obtained for all patients. MAIN OUTCOMES AND MEASURES Time needed for intraoperative CT scan was measured and trends were analyzed. Covariates included age, sex, complexity of fracture, procedure type, total scan time, surgeon, and need for intraoperative revision based on intraoperative CT findings. RESULTS Thirty-eight cases were identified, including 30 males (79%) and 8 females (21%). The mean (SE) age was 37.4 (16.0) years (range, 7-75 years). Cases were defined as routine (18 [47%]) or complex (20 [53%]). Isolated orbital fractures were the most common fracture (23 [61%]) in both the routine (14 [78%]) and complex (9 [45%]) cases. The mean (SE) total scan time was 14.5 (4.9) minutes (range, 6-27 minutes) and did not differ based on complexity (P = .34). Intraoperative revisions were performed in 9 patients (24%) and were more common in complex (n = 8) than routine (n = 1) cases (P = .004). There was no reduction in total scan time during the study period (P = .22). The mean (SE) scan time for the most experienced surgeon was 3.78 (1.53) minutes shorter than for the other surgeons as a group (P = .02). CONCLUSIONS AND RELEVANCE Current intraoperative CT scanning techniques are rapid, averaging 14.5 minutes per case. No decrease in total scan time was noted during the study; however, the surgeon most experienced with the CT software had the shortest total scan times. Intraoperative revisions were most common in complex cases. We recommend surgeons consider the use of intraoperative CT imaging for maxillofacial reconstruction, particularly in complex procedures. LEVEL OF EVIDENCE NA.

show abstract

mentioning

confidence: 99%

Use of Intraoperative Computed Tomography for Maxillofacial Reconstructive Surgery

Shaye

Tollefson

Strong

2015

JAMA Facial Plast Surg

View full text Add to dashboard Cite

show abstract

“…The liberal use of MDCT has become a concern because the ED exceeds that of plain radiography at an average of 1.5–2.9 mSv per facial bone CT compared to 0.02–0.1 mSv for x‐ray . The accumulative dose from facial bone trauma would increase over time due to ongoing imaging through the treatment and follow‐up phases . The substantial ED attributed to MDCT warrants ongoing research to optimise dose and prevent reversal of the risk‐benefit ratio .…”

Section: Discussionmentioning

confidence: 99%

“…The substantial ED attributed to MDCT warrants ongoing research to optimise dose and prevent reversal of the risk‐benefit ratio . The dose to patients from MDCT depends upon the technique factors and protocols used; examples of average exposures are shown in Table …”

Section: Discussionmentioning

confidence: 99%

“…The application of intraoperative CT has been shown to reduce the number of MDCT scans during the treatment and recovery phases by eliminating the need for pre‐operative and post‐operative scans. The use of intraoperative CT is supported in the literature for the repair of complex facial fractures . Intraoperative imaging provides real‐time feedback on the facial anatomy during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies conclude that the impact of intraoperative CT is significant, with surgical decisions affected in up to 2/3 of patients . Consolidation of optimal fracture reduction limits the need for additional corrective procedures and subsequent repeat CT imaging . There is limited literature on dose with the use of intraoperative MDCT and a more comprehensive investigation would be beneficial.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Dose reduction in CT imaging for facial bone trauma in adults: A narrative literature review

Hooper

Eccles

Milliken

et al. 2019

J of Medical Radiation Sci

View full text Add to dashboard Cite

Trauma to the facial area accounts for a significant number of admissions to the emergency department. Diagnostic imaging is almost always required, and is critical in determining patient management. Multi‐detector computed tomography (MDCT) appears consistently in the literature as the gold‐standard imaging modality for facial bones, but results in a high radiation dose to the patient. This makes the application and advancement of dose reduction and dose optimisation methods vital. This narrative review presents a critical analysis of the literature concerning diagnostic imaging of facial bone trauma, with an emphasis on dose reduction methods for MDCT. Databases including Pubmed, Medline, Web of Science and Scopus were used to investigate this topic, with the key words: facial bone trauma, computed tomography (CT) imaging and dose reduction. Exclusion criteria included studies on nasal bone fracturing, dental imaging, elective surgeries and paediatric imaging. The literature shows overwhelming support for MDCT, given its accuracy, efficiency and ease of operation. Noise reducing reconstruction algorithms show promise as a successful method of dose reduction in facial bone imaging. Investigations of more innovative techniques also appear within the literature, including diagnostic cone‐beam CT (CBCT), intraoperative CBCT and dual‐source CT (DSCT), but further research is required to confirm their clinical value.

show abstract

Trauma to the Nose and Face

Das

2017

Trauma in Otolaryngology

View full text Add to dashboard Cite

Intraoperative CT: A Teaching Tool for the Management of Complex Facial Fracture Fixation in Surgical Training

Cited by 8 publications

References 15 publications

Use of Intraoperative Computed Tomography for Maxillofacial Reconstructive Surgery

Use of Intraoperative Computed Tomography for Maxillofacial Reconstructive Surgery

Dose reduction in CT imaging for facial bone trauma in adults: A narrative literature review

Trauma to the Nose and Face

Contact Info

Product

Resources

About