Intraoperative imaging for the repair of zygomaticomaxillary complex fractures: A comprehensive review of the literature

Use of Intraoperative Computed Tomography for Revisional Procedures in Patients with Complex Maxillofacial Trauma

“…Among the available modalities, C-arm fluoroscopy is most commonly available but is unable to assess the orbital floor. 11 The orbital floor can be assessed with ultrasonography but with less accuracy than CT scans. 12 , 13 Additionally, the maxillozygomatic and sphenozygomatic articulations are difficult to assess with both fluoroscopy and ultrasonography.…”

“… 12 , 13 Additionally, the maxillozygomatic and sphenozygomatic articulations are difficult to assess with both fluoroscopy and ultrasonography. 11 Overall, all articulation points of the zygoma, the zygomatic arch contour, and the orbital floor are most accurately assessed with CT scan. Intraoperative spiral CT has been described for ZMC fractures, but practical limitations such as the weight and the size of the equipment significantly restrict its usage.…”

Virtual surgical planning for orbital reconstruction

“…In this regard, advances in computer imaging have enhanced the surgeon's ability to safely dissect the internal orbit, have allowed for the design and manufacture of standard implants for orbital reconstruction, planning for correction of secondary deformities, quantitative assessment of fracture reduction and volume restoration, and have improved the ability to visualize, in real-time, the orbital anatomy during dissection. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 …”

“…Advances in CT have improved the understanding of these injuries and the complex 3D anatomy that needs to be restored for successful management. 7 8 9 10 11 12 13 Restoration of the sphenozygomatic articulation in the lateral orbit remains the most reliable predictor of a successful reduction but is difficult to assess without surgical access to the internal orbit. 7 12 27 28 29 Furthermore, management of the orbital floor remains controversial among patients with ZMC fractures.…”

Commentary on: The Role of Postoperative Imaging after Orbital Floor Repair

“…More information on this debate is provided by highvolume centers where at least four centers have provided the information that intraoperative revision rates approach 20% when intraoperative CT scans are available. [1][2][3][4][5][6][7][8] What is not known is the clinical importance of these revisions to patient outcomes and to improvements in the functional and aesthetic consequences of these revisions. We must assume, however, from presentations and publications, that those employing intraoperative CT scans find them essential to quality control, especially in the challenging case (Grant M, personal communication).…”