Clinical Paper
Trauma
Intraoperative imaging of zygomaticomaxillary complex fractures using a 3D C-arm system

https://doi.org/10.1016/j.ijom.2004.09.010Get rights and content

Abstract

After preclinical studies and evaluation of radiation exposures, intraoperative three-dimensional (3D) C-arm based imaging is now available for the facial skeleton.

Fourteen patients admitted for surgical treatment of zygomaticomaxillary complex (ZMC) fractures were included in the study. Preoperative diagnostics and surgical treatment were performed as usual. Intraoperatively, after open reduction, a cone-beam computed tomography (CBCT) dataset was generated using the SIREMOBIL Iso-C3D (Siemens Medical Solutions, Erlangen, Germany). After DICOM-import in eFilm Workstation™ axial, coronal and sagittal reconstructions were evaluated by five examiners with the help of six defined criteria.

In our study, secondary reconstructions were available after 6 min, excluding the time needed for the evaluation of the images. Especially the positioning of the isocentre of the SIREMOBIL Iso-C3D proved to be uncomplicated. Because of the size of the datasets, assessment of the symmetry of the malar projection proved difficult. Best scoring results were found regarding the visualization of the fragment position, bony anchorage of the screws and the fitting of the plates. Remarkable was the low level of metal artefacts in primary and secondary reconstructions.

In conclusion, our results demonstrate intraoperative CBCT using the SIREMOBIL Iso-C3D suitable for assessment of postoperative results following ZMC reduction.

Section snippets

Materials and methods

Fourteen patients admitted to the Department of Oral and Maxillofacial Surgery 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. Eleven patients were male and three female. Patients’ age ranged from 21 to 83 years (average age 43.9 years). Preoperative diagnostics and surgical treatment involving open reduction and internal fixation under general anaesthesia were performed

Results

The intraoperative handling of the system proved to be uncomplicated (Fig. 1). One dataset was sufficient to visualize all fractures of the midface in all patients intraoperatively (Fig. 2, Fig. 3). The isocentre was placed at the level of the sinus floor, paranasal to the side of the fracture and median in cases of bilateral fractures. Conventional postoperative radiographs could therefore be omitted. Because of the full automatic aperture, radiation exposure varied depending especially on the

Discussion

This study was performed with the intention of evaluating the use of intraoperative CBCT in cases of ZMC fractures on the basis of a total of 14 intraoperative datasets. Because fluoroscopy is usually performed by the surgeons themselves, the 3D fluoroscopic datasets were evaluated by surgeons and not by radiologists. Comparison of intraoperative CBCTs with CT or conventional images of identical situations would have led to double examinations of patients, therefore, we evaluated this

Acknowledgments

The authors thank Doris Beckmann and Axel Hebecker from Siemens Medical Solutions for their technical support.

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