Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes

Sritharan, R.; Arya, R.; Abdelrahman, A.; Parmar, S.; Sharp, I.; Breeze, J.

doi:10.1016/j.bjoms.2023.03.010

Cited by 2 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 Intraoperative assessment using iCT , however, is not routine in many centres in Australia, despite its established use in other surgical specialties, 2 descriptions of its use in craniofacial trauma since the 1990s 3 and calls for it as a standard-of-care. 1,4 The craniofacial skeleton is a complex structure owing to its various convexities and concavities, sinonasal elements, biomechanical buttresses, visceral and occlusal components, and neurovascular structures. Traditional approaches to fixation of the craniofacial skeleton are via limited exposures, such as the temporal (Gillies) approach for zygomatic arch reduction and the retromandibular approach to a subcondylar mandible fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Financial concerns are important when integrating changes in technology into practice. Intraoperative CT is cost-effective though costs will be significantly reduced if hospitals already own the technology, 4 as all Australian trauma hospitals should.…”

Section: Discussionmentioning

confidence: 99%

“…It is beyond the scope of this article to further elucidate cost-effectiveness though it is clear preventing only a few revisions would justify changing to iCT use as standard of care. 4,7 CONCLUSION…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intraoperative computed tomography for the management of traumatic complex facial fractures: a narrative review

Haines,

Karunaratne,

Alani

et al. 2024

Australas J Plast Surg

View full text Add to dashboard Cite

Successful facial reconstruction requires accurate restoration of the concealed three-dimensional facial skeleton. The key rationale for intraoperative computed tomography (iCT) is that it facilitates the most comprehensive assessment of fracture reduction. Real-time visual feedback is now considered an essential component in hand, spine and general orthopaedic surgery. Frequently proposed as the new gold standard of care, iCT has been widely adopted in maxillofacial surgery, especially internationally. In contrast, our Australian experience is that access to iCT and therefore uptake is relatively lacking. The craniofacial skeleton is a complex structure owing to its various convexities and concavities, sinonasal elements, biomechanical buttresses, visceral and occlusal components and neurovascular structures. Classic approaches to open reduction internal fixation aim to reduce incisions to prevent complications such as ectropion, salivary leak or nerve damage. However, intraoperative assessment of fractures in minimally-invasive techniques are hindered by the limited extent of exposure, especially in the setting of complex fracture patterns or those that involve dynamic or functional endpoints. With iCT, surgeons may visualise, adjust and revise fixation without wide exposure while the patient is on the operating table. This obviates an additional operation that may be required due to an unsatisfactory fixation. iCT is cost-effective and reduces radiation exposure. Challenges in integrating iCT include competing for availability with other specialties, training staff and lack of awareness about the benefits this technology offers. This narrative review discusses the role of iCT in the modern Australian operating theatre.

show abstract