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. 2025 Sep:134:111771.
doi: 10.1016/j.ijscr.2025.111771. Epub 2025 Aug 5.

Intraoperative ultrasonographic evaluation of inferior orbital rim reduction in non-comminuted zygomatic fractures: A case series of six patients

S Morand  1 , E Lange  2 , A Lari  3 , B Alali  3 , F Almukaimi  3 , A Gleizal  2
Affiliations

Intraoperative ultrasonographic evaluation of inferior orbital rim reduction in non-comminuted zygomatic fractures: A case series of six patients

S Morand et al. Int J Surg Case Rep. 2025 Sep.

Abstract

Introduction and importance: Zygomatic fractures are common in maxillofacial trauma and often require surgical intervention for the restoration of facial symmetry. The inferior orbital rim significantly influences cheekbone asymmetry. The management of zygomatic fractures involves estimating the adequacy of reduction by comparing the malar projection on the fracture and healthy sides. This clinical approach is subjective and lacks precision.

Presentation of case: Six consecutive patients with non-comminuted zygomatic fractures were included in the study. Ultrasound was performed pre- and post-reduction during the surgery to visualize the fracture site and measure the displacement by visualizing the periosteal discontinuity. The results were compared with those of pre- and post-operative CBCT scans.

Discussion: Ultrasound demonstrated comparable efficacy to CBCT for assessing fracture reduction. Unlike CBCT, ultrasound involves no radiation exposure and allows for real-time intra-operative assessment, potentially reducing the need for revision surgery.

Conclusion: Ultrasound is a precise and practical modality for evaluating zygomatic fracture reduction during J-hook procedures. It offers a radiation-free, inexpensive and readily available modality that improves intra-operative decision-making.

Keywords: Case report; Intra-operative ultrasonography; Orbital rim; Zygomatic fracture.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Intraoperative photography. Real time assessment of a zygomatic fracture reduction by ultrasonography. a: J-hook inserted below the body of the zygoma. b: ultrasound probe. c: image visualization.
Fig. 2
Fig. 2
A: CBCT measurement of orbital rim displacement. a: medial fragment of orbital rim. b: lateral fragment of orbital rim. B: Ultrasonographic measurement of orbital rim displacement for the same patient. a: medial fragment of orbital rim. b: lateral fragment of orbital rim. star: infraorbital foramen. Yellow circle: fracture site and measurement of fracture displacement. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
A: CBCT visualization of orbital rim reduction. B: Ultrasonographic visualization of orbital rim reduction. Yellow circle: fracture site. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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