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

Abstract

Introduction: Intraoperative imaging seems to be the next step to improve surgical outcome in the treatment of zygomaticomaxillary complex (ZMC) fractures. Many publications have appeared on intraoperative imaging for trauma surgery, but in most hospitals intraoperative imaging is not routinely performed for ZMC fracture repair. The goal of this review was to assess the value of intraoperative imaging in ZMC fracture repair.

Material and methods: The literature was reviewed with focus on the effects of intraoperative imaging on facial symmetry, fracture reduction and the frequency of additional reduction after intraoperative imaging in ZMC fractures.

Results: Six publications were found on the frequency of additional reduction after intraoperative imaging in ZMC fracture repair. Revision of the reduction of the zygoma was performed in 18% (95% CI 10.5%-29.0%), revision of the orbital floor was performed in 9% (95% CI 3.6%-17.2%). No publications were found on the effects of intraoperative imaging on facial symmetry or on the accuracy of fracture reduction.

Conclusions: Information obtained from intraoperative imaging often has consequences on the surgical management of ZMC fractures. However, the effect on restoration of facial symmetry and fracture reduction is yet to be established.

Keywords: Conebeam-CT; Fluoroscopy; Maxillofacial trauma; Spiral-CT; Ultrasonography; Zygomaticomaxillary complex fracture.