Intraoperative computed tomography (CT) allows surgeons to make adjustments during orbital fracture repair that may impact postoperative outcomes.
Learning/Study Objectives:
To determine the impact of intraoperative CT use on intraoperative revision and surgical outcomes for orbital fracture repair.
Methods:
A systematic review was performed in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines: the population was patients undergoing orbital fracture repair; intervention was use of intraoperative CT; comparison was patients not undergoing intraoperative CT; and outcomes were intraoperative revision rate, postoperative complications, and secondary revision surgeries. Meta-analysis was performed on the rate of intraoperative revision.
Results:
The search criteria yielded 790 articles, 377 were eligible for review, and 20 articles met criteria for analysis. In 19, intraoperative imaging led to immediate surgical corrections, with a random pooled effect size of 0.27 (0.20–0.35). Six studies reported secondary revision surgery rates (range 0–10.5%), and six studies reported postoperative complication rates (range 10–30%).
Conclusions:
Intraoperative imaging helps surgeons make precise, real-time adjustments in 27% of orbital fracture repair cases, which may improve surgical outcomes; however, more research is needed to investigate its impact on health care costs, operating time, and radiation exposure.
LeeK.Global trends in maxillofacial fractures. Craniomaxillofac Trauma Reconstr. 2012; 5(4):213–222.
3.
BurnstineMA.Clinical recommendations for repair of orbital facial fractures. Curr Opin Ophthalmol. 2003; 14(5):236–240.
4.
NowinskiD, MessoE, HedlundA. Treatment of orbital fractures: evaluation of surgical techniques and materials for reconstruction. J Craniofac Surg. 2010; 21(4):1033.
5.
BoyetteJ, PembertonJ, Bonilla-VelezJ.Management of orbital fractures: challenges and solutions [published online November 2015:2127]. OPTH. doi:10.2147/OPTH.S80463
6.
NikunenM, RajantieH, MarttilaE, SnällJ. Implant malposition and revision surgery in primary orbital fracture reconstructions. J Cranio-Maxillofac Surg. 2021; 49(9):837–844.
7.
HoelzleF, KleinM, SchwerdtnerO, et al.Intraoperative computed tomography with the mobile CT Tomoscan M during surgical treatment of orbital fractures. Int J Oral Maxillofac Surg. 2001; 30(1):26–31.
8.
CausbieJ, WaltersB, LallyJ, et al.Complications following orbital floor repair: impact of intraoperative computed tomography scan and implant material [published online May 14, 2020]. Facial Plast Surg Aesthet Med. doi:10.1089/fpsam.2020.0117
9.
StuckBA, HülseR, BarthTJ. Intraoperative cone beam computed tomography in the management of facial fractures. Int J Oral Maxillofac Surg. 2012; 41(10):1171–1175.
10.
Stanley JrRB.Use of intraoperative computed tomography during repair of orbitozygomatic fractures. Arch Facial Plast Surg. 1999; 1(1):19–24.
11.
EllisE.Intraoperative CT scanning in maxillofacial trauma: what is its role?. Int J Oral Maxillofac Surg. 2015; 44(Supplement 1):e5.
12.
JonesL, HeapeB, FlintB, KushnerG, AlpertB. Intraoperative use of three-dimensional C-arm for facial fractures. Int J Oral Maxillofac Surg. 2017; 46(Supplement 1):261–262.
13.
ShayeDA, TollefsonTT, StrongEB. Use of intraoperative computed tomography for maxillofacial reconstructive surgery. JAMA Facial Plast Surg. 2015; 17(2):113–119.
14.
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021; 10(1):89.
15.
CannizzaroD, RevayM, MancarellaC, et al.Intraoperative imaging O-ArmTM in secondary surgical correction of post-traumatic orbital fractures. Oral Maxillofac Surg Cases. 2017; 3(3):56–60.
16.
PatelK, ClaiborneST, KademaniD. Management of orbital fractures using intraoperative navigational surgery. A prospective case series. J Oral Maxillofac Surg. 2016; 74(9):e28–e29.
17.
CausbieJ, WaltersB, LallyJ, et al.Complications following orbital floor repair: impact of intraoperative computed tomography scan and implant material. Facial Plast Surg Aesthetic Med. 2020; 22(5):355–361.
18.
NazimiAJ, NabilS. Intraoperative computed tomography image fusion for orbital blowout fracture reconstruction. Arch Orofac Sci. 2021; 16(1):1–12.
19.
HarrisR, PressS. Intraoperative computed tomography for complex midfacial and orbital Trauma. J Oral Maxillofac Surg. 2012; 70(9):e-18.
20.
WildeF, LorenzK, EbnerA-K, KraussO, MaschaF, SchrammA. Intraoperative imaging with a 3D C-arm system after zygomatico-orbital complex fracture reduction. J Oral Maxillofac Surg. 2013; 71(5):894–910.
21.
BoradV, LaceyMS, HamlarDD, DresnerHS, YadavaGK, SchubertW. Intraoperative imaging changes management in orbital fracture repair. J Oral Maxillofac Surg. 2017; 75(9):1932–1940.
22.
GohEZ, BullisS, BeechN, JohnsonNR. Intraoperative computed tomography for orbital reconstruction: a systematic review [published online May 18, 2023]. Int J Oral Maxillofac Surg. doi:10.1016/j.ijom.2023.05.002
23.
ChoiA, SissonA, OlsonK, SivamS. Predictors of delayed enophthalmos after orbital fractures: a systematic review. Facial Plast Surg Aesthet Med. 2022; 24(5):397–403.
24.
LobaP, NowakowskaO, MarczykW, SokalskaK, Broniarczyk-LobaA. [Diplopia as a factor influencing occupational and social activities of people after orbital trauma]. Med Pr. 2012; 63(5):541–546.
25.
LevineE, DegutisL, PruzinskyT, ShinJ, PersingJA. Quality of life and facial trauma: psychological and body image effects. Ann Plastic Surg. 2005; 54(5):502–510.
26.
SharmaG, KaurA. Quality of life after orbito-facial trauma. Orbit. 2017; 36(6):407–410.
27.
HattSR, LeskeDA, KirgisPA, BradleyEA, HolmesJM. The effects of strabismus on quality of life in adults. Am J Ophthalmol. 2007; 144(5):643–647.
28.
McBainHB, AuCK, HancoxJ, et al.The impact of strabismus on quality of life in adults with and without diplopia: a systematic review. Surv Ophthalmol. 2014; 59(2):185–191.
ConforteJJ, AlvesCP, Sánchez MdelP, PonzoniD. Impact of trauma and surgical treatment on the quality of life of patients with facial fractures. Int J Oral Maxillofac Surg. 2016; 45(5):575–581. doi:10.1016/j.ijom.2015.11.022
31.
MichelsKS, CzyzCN, CahillKV, FosterJA, BurnsJA, EvermanKR. Age-matched, case-controlled comparison of clinical indicators for development of Entropion and Ectropion. J Ophthalmol. 2014; 2014:231487.
32.
DhabariaH, KolariV, SequeiraJ, ShahA. Evaluation of infraorbital nerve recovery and its effect on quality of life following open reduction and internal fixation of zygomaticomaxillary complex fractures—an evaluative study. Ann Maxillofac Surg. 2022; 12(2):128.
MalhamGM, Wells-QuinnT. What should my hospital buy next?—Guidelines for the acquisition and application of imaging, navigation, and robotics for spine surgery. J Spine Surg. 2019; 5(1):155–165.
36.
PitteloudN, GamulinA, BareaC, DametJ, RaclozG, Sans-MerceM. Radiation exposure using the O-arm® surgical imaging system. Eur Spine J. 2017; 26(3):651–657.
37.
SritharanR, AryaR, AbdelrahmanA, ParmarS, SharpI, BreezeJ.Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes [published online March 30, 2023]. Br J Oral Maxillofac Surg. S0266-4356(23)00084-0. doi:10.1016/j.bjoms.2023.03.010
38.
TowerI, LaskoLA, KathjuS. Secondary surgery for cicatricial complications of facial injury. J Oral Maxillofac Surg. 2010; 68(4):751–755.
39.
BrucoliM, ArcuriF, CavenaghiR, BenechA. Analysis of complications after surgical repair of orbital fractures. J Craniofac Surg. 2011; 22(4):1387–1390.
40.
ScawnRL, LimLH, WhippleKM, et al.Outcomes of orbital blow-out fracture repair performed beyond 6 weeks after injury. Ophthalmic Plas Reconstr Surg. 2016; 32(4):296–301.
41.
NamSB, BaeYC, MoonJS, KangYS. Analysis of the postoperative outcome in 405 cases of orbital fracture using 2 synthetic orbital implants. Ann Plast Surg. 2006; 56(3):263–267.
GuptaS, MehrotraD, SinghPK, VigneshU, BhaveS, KatroliaR. Quality of life after reconstruction of traumatic orbital floor defects using titanium mesh and medpore: a randomised controlled trial. J Oral Biol Craniofac Res. 2021; 11(2):200–203.
PohlenzP, BlessmannM, BlakeF, HeinrichS, SchmelzleR, HeilandM. Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2007; 103(3):412–417.
46.
SinghM, RicciJA, CatersonEJ. Use of intraoperative computed tomography for revisional procedures in patients with complex maxillofacial trauma. Plast Reconstr Surg. 2015; 3(7):e463.
47.
ZimmererRM, GellrichNC, Von BülowS, et al.Is there more to the clinical outcome in posttraumatic reconstruction of the inferior and medial orbital walls than accuracy of implant placement and implant surface contouring? A prospective multicenter study to identify predictors of clinical outcome. J Cranio-Maxillofac Surg. 2018; 46(4):578–587.
48.
SintonenH.The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001; 33(5):328–336.
49.
UkpongDI, UgbokoVI, NdukweKC, GbolahanOO. Health-related quality of life in Nigerian patients with facial trauma and controls: a preliminary survey. Br J Oral Maxillofac Surg. 2008; 46(4):297–300.
50.
CuddyK, KhatibB, BellRB, et al.Use of intraoperative computed tomography in craniomaxillofacial trauma surgery. J Oral Maxillofac Surg. 2018; 76(5):1016–1025.
51.
EllisE, PerezD. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg. 2014; 72(10):1975–1983.
52.
GanderT, BlumerM, RostetterC, et al.Intraoperative 3-dimensional cone beam computed tomographic imaging during reconstruction of the zygoma and orbit. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 126(2):192–197.
53.
HingsammerL, SeierT, JohnerJPet al.Does zygomatic complex symmetry differ between healthy individuals and surgically treated patients using intraoperative 3-dimensional cone beam computed tomographic imaging?. J Oral Maxillofac Surg. 2020; 78(5):798.e1–798.e7.
54.
HoelzleF, KleinM, SchwerdtnerO, et al.Intraoperative computed tomography with the mobile CT Tomoscan M during surgical treatment of orbital fractures. Int J Oral Maxillofac Surg. 2001; 30(1):26–31.
55.
KumarS, RattanV, SharmaP. Role of intraoperative computerized tomographic scan in the management of zygomatico-orbital complex fractures. J Oral Maxillofac Surg. 2017; 75(10):e410.
56.
NazimiAJ, KhooSC, NabilSet al.Intraoperative computed tomography scan for orbital fracture reconstruction. J Craniofac Surg. 2019; 30(7):2159–2162.
57.
NguyenE, LockyerJ, ErasmusJ, LimC. Improved outcomes of orbital reconstruction with intraoperative imaging and rapid prototyping. J Oral Maxillofac Surg. 2019; 77(6):1211–1217.
58.
SchoenR, MetzgerM, SchmelzeisenR. Orbital reconstruction using standardized 3D titanium orbital mesh implants in combination with intraoperative quality control by cone beam CT scan. Int J Oral Maxillofac Surg. 2011; 40(10):1018.
59.
ShayeDA, TollefsonTT, StrongEB. Use of intraoperative computed tomography for maxillofacial reconstructive surgery. JAMA Facial Plast Surg. 2015; 17(2):113–119.
60.
ShyuVB, ChenHH, ChenCH, ChenCT. Clinical outcome following intraoperative computed tomography-assisted secondary orbital reconstruction. J Plast Reconstr Aesthet Surg. 2021; 74(2):341–349.
61.
StuckBA, HülseR, BarthTJ. Intraoperative cone beam computed tomography in the management of facial fractures. Int J Oral Maxillofac Surg. 2012; 41(10):1171–1175.
