Use of Intraoperative Computed Tomography in Craniomaxillofacial Trauma Surgery

Cuddy, Karl; Khatib, Baber; Bell, R. Bryan; Cheng, Allen; Patel, Ashish; Amundson, Melissa; Dierks, Eric J.

doi:10.1016/j.joms.2017.12.004

Cited by 62 publications

(30 citation statements)

References 23 publications

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“…During the last 3 years, OMFS service at GMH implemented the use of patient-specific technologies (ie, intraoperative computed tomography scans, 3D printing, and intraoperative navigation). These technologies have been shown to improve the quality of repair, 25 decrease reoperation rate, 25,26 decrease operative time, and overall LOS. Investigating details of these variables are a part of an ongoing, separate project.…”

Section: Discussionmentioning

confidence: 99%

Review of Orbital Fractures in an Urban Level I Trauma Center

Amin

Al-Mulki

Henriquez

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Objective: To perform a comprehensive review and analysis of surgically treated orbital fractures. Study Design: Retrospective cohort chart review study for surgically treated orbital fractures during 5 years. Results: A total of 173 patients (average age 41.6 years) were diagnosed with orbital fractures. Most were male with a ratio of 3.3:1. Most fractures were caused by assault (39.3%); 22.5% of the cases were bilateral. The left orbit (40.5%) was fractured more than the right. The orbital floor (97.1%) was the most common anatomic location and the maxilla (65.3%) was the most commonly involved bone. The average time from trauma to surgical intervention was 8.7 ± 14.6 days and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision (63%) was the most commonly used incision, and nonresorbable implant (92.7%) was the most commonly used implant. Finally, the length of stay for the repair of a simple orbital fracture was less than for complex orbital fracture (1.5 days and 5.9 days, respectively). Conclusion: Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for a uniform high quality of surgical care for patients with maxillofacial fractures.

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Section: Discussionmentioning

confidence: 99%

Review of Orbital Fractures in an Urban Level I Trauma Center

Amin

Al-Mulki

Henriquez

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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“…Although first described in 1999, recent years have seen advances in application and safety of intraoperative CT. 26 While utilized in many areas, such as oncologic resection and reconstruction or orthognathic surgery, the most widespread use of intraoperative CT remains in the repair of maxillofacial skeletal trauma, particularly in midface trauma, where aesthetic and functional concerns limit direct visualization of bony structures. 27 The traditional method of confirming adequate restoration of functional and cosmetically favorable anatomy through postoperative imaging has long been plagued by the inherent risk and costliness of secondary revision maxillofacial procedures. Immediate revision rates based on intraoperative imaging have been reported to be 15 to 31% and tend to be highest in orbital, zygomaticomaxillary, and naso-orbito-ethmoidal repairs.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

“…Immediate revision rates based on intraoperative imaging have been reported to be 15 to 31% and tend to be highest in orbital, zygomaticomaxillary, and naso-orbito-ethmoidal repairs. [27][28][29] Postoperative outcomes such as diplopia following orbital reconstruction and need for revision surgery have been shown to be significantly improved by the use of intraoperative CT. [29][30][31] Interestingly, in the repair of isolated unilateral zygomaticomaxillary complex fractures, intraoperative CT has even been found to facilitate repair such that malar symmetry in repaired patients is no different than in patients with no trauma history. 32 The safety of intraoperative CT has also improved in recent years, as advances in imaging modalities such as improved resolution of cone beam CT have enabled detailed intraoperative imaging with reductions in radiation dose, minimal increases in operative time, and subsequent exposure to general anesthetic.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery

et al. 2020

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The field of facial plastic and reconstructive surgery is privy to a myriad of technological advancements. As innovation in areas such as imaging, computer applications, and biomaterials progresses at breakneck speed, the potential for clinical application is endless. This review of recent progress in the implementation of new technologies in facial plastic surgery highlights some of the most innovative and impactful developments in the past few years of literature. Patient-specific surgical modeling has become the gold standard for oncologic and posttraumatic reconstructive surgery, with demonstrated improvements in operative times, restoration of anatomical structure, and patient satisfaction. Similarly, reductions in revision rates with improvements in learner technical proficiency have been noted with the use of patient-specific models in free flap reconstruction. In the cosmetic realm, simulation-based rhinoplasty implants have drastically reduced operative times while concurrently raising patient postoperative ratings of cosmetic appearance. Intraoperative imaging has also seen recent expansion in its adoption driven largely by reports of eradication of postoperative imaging and secondary—often complicated—revision reconstructions. A burgeoning area likely to deliver many advances in years to come is the integration of bioprinting into reconstructive surgery. Although yet to clearly make the translational leap, the implications of easily generatable induced pluripotent stem cells in replacing autologous, cadaveric, or synthetic tissues in surgical reconstruction are remarkable.

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“…26 Cuddy et al reviewed 161 patients and found the overall intraoperative CT-directed revision rate was 28% (by fracture subsite: 31% orbital, 24% ZMC, 8% Le Fort I, 23% Le Fort II and III, 23% NOE, 13% mandible, and 0% frontal sinus). 27 Routine use of intraoperative imaging depends on the availability of the O-arm. A downside is that the patient is exposed to radiation from CT imaging, and surgeons must wear lead during surgery.…”

Section: Perioperative Imagingmentioning

confidence: 99%

Surgical Management of Panfacial Fractures

et al. 2019

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The evaluation and management of a patient with panfacial fractures are multifaceted. Herein, we describe basic facial skeletal anatomy, considerations for airway securing, and common concurrent injuries. Finally, we discuss primary and secondary reconstructions of facial trauma including sequencing of repair, available landmarks, and the utility of intraoperative computed tomography imaging and virtual surgical planning with custom implants.

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Use of Intraoperative Computed Tomography in Craniomaxillofacial Trauma Surgery

Cited by 62 publications

References 23 publications

Review of Orbital Fractures in an Urban Level I Trauma Center

Review of Orbital Fractures in an Urban Level I Trauma Center

Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery

Surgical Management of Panfacial Fractures

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