Impact of intraoperative cone beam computed tomography in the management of zygomatic fractures - 01/12/20

Doi : 10.1016/j.jormas.2020.11.005

Mélanie Pons ^a,^b,⁎ , Jean-Christophe Lutz ^c,^d,^e, Brice Chatelain ^a, Elise Weber ^a, Aude Barrabé ^a, Christophe Meyer ^a,^f, Nicolas Sigaux ^g,^h, Aurélien Louvrier ^a,^b
^a Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France
^b University of Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Interactions/Cell and Gene Engineering, 25000 Besançon, France
^c Department of Oral and Maxillofacial Surgery, University Hospital of Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France
^d Laboratory of Engineering Science, Computer Science and Imaging, CNRS, ICUBE University of Strasbourg, 2 rue Boussingault, 67000 Strasbourg, France
^e INSERM, “Regenerative Nanomedicine” Laboratory, UMR 1260, Faculty of Medicine, 67085 Strasbourg Cedex, France
^f Nanomedicine Lab, Imagery and Therapeutics, EA 4662, UFR Sciences et Techniques, University of Franche-Comté, Route de Gray, 25030 Besançon Cedex, France
^g Department of Maxillofacial Surgery and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, France
^h Claude Bernard Lyon 1 University, France

^⁎Corresponding author at: Maxillo-Facial Surgery Department, CHU Besançon, 3 Bd Fleming, 25030 Besançon cedex, France.Maxillo-Facial Surgery DepartmentCHU Besançon3 Bd FlemingBesançon cedex25030France

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Abstract

Aim

To evaluate the impact of intraoperative cone beam computed tomography (CBCT) assessment for the surgical management of zygomatic bone fracture (ZF).

Methods

A prospective study was conducted on patients operated on for unilateral ZF during a two-year period. Repositioning of the fractured zygoma was assessed intraoperatively by measuring the position of malar eminences in three dimensions on CBCT. A difference of more than 2 mm between both sides was considered significant and the reduction was judged inadequate. Surgical procedure was adapted to intraoperative imaging findings.

Results

The surgical procedures of 47 patients treated for ZF were analyzed. In 15% of the cases (7 patients), the intraoperative CBCT showed an inadequate reduction while the morphological results seemed correct. Those patients benefited from an immediate correction of the reduction. From these 7 patients, reduction was optimized further without the need of osteosynthesis in one case, additional osteosynthesis was performed in 4 cases and 2 patients required both reduction and osteosynthesis revision.

Conclusion

Intraoperative CBCT control helps to achieve anatomic repositioning in case of ZF. It may reduce the risk of under-treatment and possible reoperation, and of over-treatment meaning systematic ORIF in all fractures.

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Keywords : Intraoperative imaging, CBCT, Zygoma, Zygomatic fracture, Maxillofacial surgery, Traumatology