Use of C-Arm to Assess Reduction of Zygomatic Complex Fractures: A Comparative Study

Maheedhar, Atmakuru Venkata; Ravindran, C; Azariah, Emmanuel

doi:10.1055/s-0036-1592085

Cited by 13 publications

(6 citation statements)

References 20 publications

(25 reference statements)

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“…There is no simple and reliable method to assess proper reduction of zygomatic fractures. Various methods like USG, 27 CT, 28 and C-arm 29 had been used in attempt to check proper reduction and restoration of orbital volume. But there are practical difficulties in these methods.…”

Section: Discussionmentioning

confidence: 99%

Validation of Modified Hertel Exophthalmometer

Jamal

Azariah

Pandyan

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Study Design: This is a correlation study. Objective: The objective was to obtain normative values from modified Hertel exophthalmometer, to compare difference in values between modified and standard Hertel exophthalmometer and to statistically analyze for correlation. Methods: The study to validate the modification done to Hertel exophthalmometer was performed at the Department of Oral and Maxillofacial Surgery at our institute. Informed consent was obtained from patients; measurement in 100 volunteers was made with Hertel and modified Hertel exophthalmometer by a single observer, and the measurements taken by the 2 devices were tabulated along with variables such as age and gender. Data were collected and statistical analysis was performed to compare and correlate the values between standard and modified exophthalmometer. Differences of ocular protrusion values in gender and age were also calculated. Results: There has been no statistically significant difference in the normative data between standard Hertel and modified Hertel exophthalmometer and in relation to age and gender. Conclusions: The modification of the Hertel exophthalmometer is validated and can also be used for relative exophthalmometry to assess the need for treatment and to evaluate the globe position and orbital volume intraoperatively. The proposed modification of the instrument allows it to be used in cases when one of the lateral orbital walls is fractured or displaced due to trauma.

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Section: Discussionmentioning

confidence: 99%

Validation of Modified Hertel Exophthalmometer

Jamal

Azariah

Pandyan

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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“…There currently exists, only a small number of studies that have investigated the use of intra-operative CT scans in the management of ZMC fractures. [5][6][7][8][9][10][11][12][13][14] Most of the studies involve small patient sample sizes and none provide level 1 evidence. Many of these studies conclude that the intraoperative CT scans can improve fracture reduction and revision surgery rates.…”

Section: Background Zygomaticomaxillary Complex and Zygomatic Arch Frmentioning

confidence: 99%

A Study Protocol for a Randomised Controlled Trial Evaluating the Effects of Intraoperative Computed Tomography on the Outcomes of Zygomatic Fractures

Higgins

Hurrell

Harris

et al. 2019

Preprint

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Background Zygomaticomaxillary complex (ZMC) and zygomatic arch (ZA) fractures are common injuries resulting from facial trauma and frequently require surgical management.1 A substantial number of post-operative functional and cosmetic complications can arise from the surgical management of these fractures. These include scarring, inadequate facial profile restoration, facial asymmetries and diplopia.2-4 Intuitively, most of these aforementioned complications arise as a result of inadequate fracture reduction, however current standard practice is to assess reduction post-operatively through plain radiographs or computed tomography (CT) scans. The role of intra-operative computed tomography (CT) scanning to assess the reduction of ZMC/ZA fractures and the potential impact on complications, has thus far not been established. Methods This is a prospective randomised controlled trial currently being undertaken at the Royal Brisbane and Women’s Hospital. All patients who require operative management of their ZMC or ZA fractures are offered enrollment in the trial. The patients are randomised into two groups: interventional (intra-operative CT) and control (no intra-operative CT). All patients from both groups will have post-operative radiographs taken. From these radiographs, the reduction of the ZMC and/or ZA fracture is graded by a blinded assessor. Patients will be reviewed in clinic at one and six weeks post-surgery. During these consultations, all patients will be assessed for scarring, diplopia, facial profile restoration and need for revision surgery. Discussion Many complications associated with surgical management of ZMC and ZA fractures involve poor aesthetic results as a direct consequence of inadequate fracture reduction. Inadequate fracture reduction is predictable given that small incisions are used and only limited visualisation of the fractures is possible during the procedure. This is due to a desire to limit scarring and reduce the risk of damage to vital structures in an aesthetically sensitive region of the body. It follows that an intraoperative adjunctive tool such as a CT scan, which can assist in visualisation of the fractures and the subsequent reduction, could potentially improve reduction and reduce complications.

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“…[4][5][6][7][8][9] Fluoroscopy with a C-arm has been proposed to aid in the reduction of ZMC fractures. 10 While not resource-intensive, this technology fails to allow three-dimensional assessment of the operative field. Intraoperative computed tomography (CT) has been used in craniomaxillofacial trauma surgery for roughly 20 to 25 years 11 and has the potential to improve patient outcomes in the management of craniomaxillofacial trauma.…”

Section: Introductionmentioning

confidence: 99%