C-Arm-Guided Reduction of Zygomatic Fractures Revisited

Imai, Tomoaki; Michizawa, Masahiro; Fujita, Gentaro; Shimizu, Hidetaka; Ota, Yoshiyuki; Kitamura, Tetsuhisa; Inoue, Hiroshi; Kai, Tatsuro

doi:10.1097/ta.0b013e31821280a0

Cited by 19 publications

(8 citation statements)

References 23 publications

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“…7 In such scenario either re-surgery or leaving in compromised state will be only options. USG, 20 Navigation, 21 C-arm CBCT, 22,23 C-arm fluoroscopy 24,25 have been described to intraoperatively determine the adequacy of reduction.…”

Section: Discussionmentioning

confidence: 99%

Use of ultrasonography in reduction of isolated zygomatic arch fracture

Dhungel¹,

Singh²

2020

JCMC

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Background: Isolated zygomatic arch fractures, managed by closed methods, can be inadequate leading to facial asymmetry. Assessment of the reduction and ensuring correct alignment of fractured fragments in the operation table always avoids next surgery. This study aims to determine intraoperative, adequacy of reduction of by use of ultrasound in isolated zygomatic arch fracture. Methods: During the closed reduction of isolated zygomatic arch linear probe of ultrasound was used to check the continuity of the echogenic line. The intraoperative ultrasound finding was compared with the gold standard CT scan. Results: Ultrasound has 100% sensitivity and 80 % specificity. It also has high precision and accuracy to determine the reduction of the fractured bone. Conclusions: Ultrasound is a handy tool in the reduction of zygomatic arch fracture. It not only shows but also guides to adequate reduction.

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Section: Discussionmentioning

confidence: 99%

Use of ultrasonography in reduction of isolated zygomatic arch fracture

Dhungel¹,

Singh²

2020

JCMC

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“…Intraoperative C-arm imaging appears to be a good option in the reduction of a zygomatic arch or simple ZMC fracture. [8,9] The surgeons could make zygomatic arch fracture well reduction with immediate imaging no matter of simple or comminuted arch fracture. [8] For a simple ZMC fracture, one-point fixation with immediate C-arm imaging could achieve the same effects as two-point fixations.…”

Section: Discussionmentioning

confidence: 99%

“…[8,9] The surgeons could make zygomatic arch fracture well reduction with immediate imaging no matter of simple or comminuted arch fracture. [8] For a simple ZMC fracture, one-point fixation with immediate C-arm imaging could achieve the same effects as two-point fixations. [8] The advantages of the above mentioned C-arm imaging technique are fewer incisional wounds, decreased operative and admission duration, fewer opportunities for secondary operation, and decreased cost of postoperative imaging.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a craniometry in a comminuted zygomaticomaxillary complex fracture

Hsu

Shih

2019

Medicine

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Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex (ZMC) fracture management. We present our experiences with this procedure and a review of the related literature. From September 2011 to October 2018, 43 patients with comminuted ZMC fracture receiving open reduction internal fixation under coronal incision were enrolled. Data on gender, age, operation time, hospital stay, duration of follow-up, vertical/horizontal differences, and complications were collected. Between-group differences (C-arm imaging vs craniometry) were evaluated using nonparametric Mann–Whitney test for continuous data and chi-square test for categorical data. No significant difference were found between the groups regarding gender, age, hospital duration, follow-up duration, and postoperative complications, except for operation time. The averaged operation time was significantly shorter in the C-arm imaging group (4.217 h) than in the craniometry group (6.193 h). The C-arm imaging group had two cases with horizontal differences >3 mm and one case with vertical differences >3 mm. The craniometry group had four cases with horizontal differences >3 mm and four cases with vertical differences >3 mm. There were no significant differences between the two groups in horizontal differences and vertical differences. Craniometry may achieve the same outcomes as C-arm imaging in comminuted ZMC fracture management; however, the former requires more time than the latter.

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“…There currently exists, only a small number of studies that have investigated the use of intra-operative CT scans in the management of ZMC fractures. [5][6][7][8][9][10][11][12][13][14] Most of the studies involve small patient sample sizes and none provide level 1 evidence. Many of these studies conclude that the intraoperative CT scans can improve fracture reduction and revision surgery rates.…”

Section: Background Zygomaticomaxillary Complex and Zygomatic Arch Frmentioning

confidence: 99%

A Study Protocol for a Randomised Controlled Trial Evaluating the Effects of Intraoperative Computed Tomography on the Outcomes of Zygomatic Fractures

Higgins

Hurrell

Harris

et al. 2019

Preprint

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Background Zygomaticomaxillary complex (ZMC) and zygomatic arch (ZA) fractures are common injuries resulting from facial trauma and frequently require surgical management.1 A substantial number of post-operative functional and cosmetic complications can arise from the surgical management of these fractures. These include scarring, inadequate facial profile restoration, facial asymmetries and diplopia.2-4 Intuitively, most of these aforementioned complications arise as a result of inadequate fracture reduction, however current standard practice is to assess reduction post-operatively through plain radiographs or computed tomography (CT) scans. The role of intra-operative computed tomography (CT) scanning to assess the reduction of ZMC/ZA fractures and the potential impact on complications, has thus far not been established. Methods This is a prospective randomised controlled trial currently being undertaken at the Royal Brisbane and Women’s Hospital. All patients who require operative management of their ZMC or ZA fractures are offered enrollment in the trial. The patients are randomised into two groups: interventional (intra-operative CT) and control (no intra-operative CT). All patients from both groups will have post-operative radiographs taken. From these radiographs, the reduction of the ZMC and/or ZA fracture is graded by a blinded assessor. Patients will be reviewed in clinic at one and six weeks post-surgery. During these consultations, all patients will be assessed for scarring, diplopia, facial profile restoration and need for revision surgery. Discussion Many complications associated with surgical management of ZMC and ZA fractures involve poor aesthetic results as a direct consequence of inadequate fracture reduction. Inadequate fracture reduction is predictable given that small incisions are used and only limited visualisation of the fractures is possible during the procedure. This is due to a desire to limit scarring and reduce the risk of damage to vital structures in an aesthetically sensitive region of the body. It follows that an intraoperative adjunctive tool such as a CT scan, which can assist in visualisation of the fractures and the subsequent reduction, could potentially improve reduction and reduce complications.

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C-Arm-Guided Reduction of Zygomatic Fractures Revisited

Cited by 19 publications

References 23 publications

Use of ultrasonography in reduction of isolated zygomatic arch fracture

Use of ultrasonography in reduction of isolated zygomatic arch fracture

Feasibility of a craniometry in a comminuted zygomaticomaxillary complex fracture

A Study Protocol for a Randomised Controlled Trial Evaluating the Effects of Intraoperative Computed Tomography on the Outcomes of Zygomatic Fractures

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