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

• Published in: International journal of oral and maxillofacial surgery Vol. 34; no. 4; pp. 369 - 375
• Main Authors: Heiland, M., Schulze, D., Blake, F., Schmelzle, R.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.06.2005; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bone Plates; Bone Screws; Cone-beam computed tomography; Dentistry; Female; Fracture Fixation, Internal - methods; Humans; Imaging, Three-Dimensional - instrumentation; Injuries of the limb. Injuries of the spine; Male; Maxillary Fractures - diagnostic imaging; Maxillary Fractures - surgery; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Oral Surgical Procedures - instrumentation; Oral Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; SIREMOBIL; Tomography, Spiral Computed - instrumentation; Traumas. Diseases due to physical agents; Zygomatic Fractures - diagnostic imaging; Zygomatic Fractures - surgery; Zygomaticomaxillary complex fracture; Zygomaticomaxillary complex fracture; Cone-beam computed tomography; SIREMOBIL; Human; Radiodiagnosis; Stomatology; Diseases of the osteoarticular system; Maxillary; Intraoperative; Fracture; Trauma; Treatment; Surgery; Zygomatic arch; Medical imagery; Computerized axial tomography
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2004.09.010

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-C 3D (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-C 3D 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-C 3D suitable for assessment of postoperative results following ZMC reduction.