Use of Intraoperative Computed Tomography for Revisional Procedures in Patients with Complex Maxillofacial Trauma

Abstract

Background: In patients with panfacial fractures and distorted anatomic landmarks of zygomatic and orbital complex, there is a risk of zygomaticomaxillary complex (ZMC) malpositioning even with the best efforts for surgical repair. This results in increased number of additional procedures to achieve accurate positioning.

Methods: We describe the usage of intraoperative C-arm cone-beam computed tomographic (CT) scan for ZMC malpositioning in a representative patient with panfacial fractures.

Results: We have successfully used intraoperative CT scan for ZMC malpositioning in 3 patients. The representative patient had ZMC malposition after the initial attempt of surgical repair without any intraoperative imaging. On using intraoperative CT scan during the next attempt, we were able to reposition the ZMC accurately.

Conclusions: Intraoperative CT scan might improve the accuracy of ZMC positioning and decrease the chances of potential additional surgeries. In patients with distorted anatomical landmarks and panfacial fractures, it can be especially helpful toward correcting ZMC malposition.

Fig. 1.

Anteroposterior view of the patient at the time of initial presentation. Note the apparent facial widening, telecanthus, and enophthalmos on the right side of the patient.

Fig. 2.

Postoperative CT scan after initial revisional procedure without the use of intraoperative imaging. Note the position of the right zygoma compared with the left with increase in the right-sided orbital volume.

Fig. 3.

Initial intraoperative CT scan at the start of the procedure with measurements taken of both orbits for comparison.

Fig. 4.

Postoperative (2 weeks) CT scan demonstrating adequate reduction of the right zygoma and similar orbital measurement [32.97 mm × 33.93 mm (R) vs 32.97 mm × 34.41 mm (L)] and volumes.