Clinical articles
Postoperative imaging of zygomaticomaxillary complex fractures using digital volume tomography

https://doi.org/10.1016/j.joms.2004.05.215Get rights and content

Purpose

Three-dimensional imaging using digital volume tomography after reduction of zygomaticomaxillary complex fractures was performed and evaluated.

Patients and methods

Ten patients admitted for surgical treatment of zygomaticomaxillary complex fractures were included in the study. All patients were male, aged 17 to 81 years (average, 43.8 years). Preoperative diagnostics and surgical treatment involving open reduction under general anesthesia were performed as usual. One to 3 days (average, 1.6 days) postoperatively, a digital volume tomography data set was generated using the NewTom 9000 (NIM s.r.l., Verona, Italy). After DICOM-import in eFilm Workstation 1.8.3 (Merge Technologies Inc, Milwaukee, WI), axial, coronal, and sagittal reconstructions were evaluated by 6 examiners with the help of 5 defined criteria.

Results

One data set was sufficient to visualize all fracture sites of the midface in all patients. Postprocessing using eFilm was successfully performed in all cases. Best scoring results were found regarding bony anchorage of screws and fitting of plates. Remarkable was the low level of metal artifacts in primary and secondary reconstructions, even in close proximity of the material. Most difficulty was encountered during the identification of the medial orbital wall, especially next to poorly ventilated ethmoidal cells. Osseous structures of older patients with decreased bone density proved difficult to visualize.

Conclusion

Digital volume tomography using the NewTom 9000 is suitable for assessment of postoperative results after zygomaticomaxillary complex reduction.

Section snippets

Patients and methods

Ten patients admitted to the Department of Oral and Maxillofacial Surgery (Nordwestdeutsche Kieferklinik) of the University Hospital Hamburg-Eppendorf for surgical treatment of ZMC fractures were included in the study. Patients with isolated blowout fractures were not included. All patients were male, aged 17 to 81 years (average, 43.8 years). Preoperative diagnostics and surgical treatment involving open reduction under general anesthesia were performed as usual. Infraorbital and intraoral

Results

One data set was sufficient to visualize all fracture sites of the midface in all patients, but the entire mandible could not be included. Therefore, in 2 patients with additional mandibular fractures a postoperative panoramic view was added. Because of the aperture automatic radiation exposure varied depending especially on the amount of osteosynthetic material present.

Postprocessing using eFilm Workstation 1.8.3 was successfully performed in all cases. Even pseudocoronal and pseudosagittal

Discussion

Computed tomography with primary coronal sections earlier and multislice systems with secondary coronal reconstructions now are the accepted standard for preoperative treatment planning of ZMC fractures. In view of radiation exposure, alternatives like ultrasound or magnetic resonance imaging have been described, but are not standard diagnostic tools, nor have they substituted the CT.17, 18 However, regarding high-contrast structures, DVT offers an alternative to CT imaging resulting in

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