Does C-Arm Guidance Improve Reduction of Zygomatic Arch Fractures?—A Randomized Controlled Trial

Menon, Akash; Karikal, Arvind; Shetty, Vikram

doi:10.1016/j.joms.2018.05.026

Cited by 15 publications

(4 citation statements)

References 15 publications

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“…Previous studies have shown a re-intervention rate for malplaced implants of 6.5-23% when peroperative CT or navigation is not used [7,[11][12][13][14]. In our study 12 patients (13%) had an early complication requiring re-intervention within 1 month, most of these re-interventions were because of malpositioned implants.…”

Section: Discussionmentioning

confidence: 49%

Treatment of orbital fractures – a critical analysis of ophthalmic outcomes and scenarios for re-intervention

Persson

Lif

Falk-Delgado

et al. 2023

JPHS

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Background: Malplaced implants in orbital reconstruction may lead to serious complications and necessitate re-intervention. The aim of this study was to describe outcomes, complications and scenarios of re-intervention in a historical case series of orbital fractures treated with free-hand orbital wall reconstruction. The main hypothesis was that early re-interventions are mainly because of malplaced implants in the posterior orbit.Methods: Retrospective review of 90 patients with facial fractures involving the orbit, reconstructed with radiopaque orbital wall implants, from 2011 to 2016. Data were obtained from medical records and computed tomography images. Recorded parameters were fracture type, ocular injury, ocular motility, diplopia, eye position, complications and re-interventions. Secondary reconstructions because of enophthalmos were volumetrically evaluated.Results: Early complications requiring re-intervention within 1 month were seen in 12 (13%) patients, where all except two were because of malplaced implants. The implant incongruence was without exception found in the posterior orbit. Late complications consisted of four (4%) cases of ectropion and five (5%) cases of entropion that needed corrective surgery. The majority of the patients with eye-lid complications had undergone repeated surgeries. Secondary orbital surgeries were performed in nine (10%) patients. Five of these patients had secondary reconstruction for enophthalmos and associated diplopia. None of these patients became completely free from either enophthalmos or diplopia after the secondary surgery.Conclusion: Re-intervention after orbital reconstruction is mainly related to malplaced implants in the posterior orbit. Incomplete results in patients requiring secondary surgery for enophthalmos infer the importance of accurate restoration of the orbit at primary surgery.Abstract presented at: Swedish surgery Week 2021 and SCAPLAS 2022.

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Section: Discussionmentioning

confidence: 49%

Treatment of orbital fractures – a critical analysis of ophthalmic outcomes and scenarios for re-intervention

Persson

Lif

Falk-Delgado

et al. 2023

JPHS

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“…13 Multiple groups have outlined the benefits of intraoperative C-arm radiography in reduction of zygomatic fractures, touting the low radiation exposure, ease of use, efficiency, lower costs, and control of fracture reduction. [14][15][16][17] The use of plain radiographs in management of isolated orbital fractures has been limited or unreported mainly due to poor visualization of details of the orbit on plain radiographs.…”

Section: Introductionmentioning

confidence: 99%

Role of Plain Radiographs in Assessing Appropriate Placement of Orbital Implants for Repair of Floor Fractures

Nikizad

Schubert

2020

Craniomaxillofacial Trauma & Reconstruction

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Intraoperative imaging is becoming increasingly common in repair of facial fractures. Many institutions do not have access to intraoperative advanced 3D imaging but have the capability of obtaining plain radiographs intraoperatively. At institutions where advanced 3D imaging is available, scout radiographs are usually obtained prior to a complete scan. These scout images can provide some information about the placement of radiopaque implants before a complete scan is performed. The aim of this study is to examine the correct anatomic positioning of an orbital floor implant using lateral plain radiographs. Titanium orbital fan implants were molded and secured to orbital floor of 14 adult dry skulls (7 males and 7 females). Lateral radiographs were obtained for both the left and the right orbits individually. The antero-posterior angle of inclination that the implant makes relative to the Frankfort horizontal plane was measured, and results were compared in the male versus female radiographs. The mean angle that the implant made with the Frankfort horizontal plane was 20.1±2.4° in the male orbits (95% CI 18.8-21.5°) and 22.6 ± 2.0° in the female orbits (95% CI, 21.4-23.7°). We found no statistically significant differences between the male and female angles ( P-value 0.62). For the combined specimens (i.e., 28 sides in 14 skulls), the overall mean angle was 21.4 ± 2.5° (95% CI, 20.4-22.3°). Based on these findings, the angle that the implant makes with the Frankfort horizontal plane on lateral cross-table plain radiographs can be used intraoperatively to assist the surgeon in confirming the appropriate placement of the implant.

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“…Traditionally, in the assessment of the reduction of zygomatic arch fractures, the surgeon uses subjective measures such as palpation of a bony step deformity, the anecdotal "pop" sounds and visual confirmation of symmetry. 4 The zygomaticomaxillary complex functions as the principle buttress of the face and is the cornerstone to an individual's aesthetic appearance. Its fracture not only creates cosmetic deformities owing to its position and facial contour, but can also cause disruption of ocular and mandibular functions.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Descriptive Study of Epidemiology of Fractures of Zygoma in Tertiary Care Hospital Over a Period of a Decade

Ramesh¹,

Mahendar²,

Kumar³

et al. 2018

jemds

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BACKGROUND Zygoma is a very crucial component, which maintains facial contour. Fracture and dislocation of this bone not only causes cosmetic defects, but also disrupts ocular and mandibular functions. Fractures can involve any of the four articulations of zygoma, which include zygomaticomaxillary complex, zygomatic complex and orbitozygomatic complex. Management depends on a thorough preoperative physical examination with special attention to the ophthalmologic assessment. Fractures involving zygoma should be repaired at the earliest, because it can cause both functional and cosmetic defects. These fractures are common in our institution and a study is being undertaken to study the causes, pattern of fractures, the diagnostic and treatment modalities adopted. The aim of this study is to analyse the cause, age and gender, incidence, sites of fracture of zygoma, various combinations of fractures, diagnostic and treatment modalities that were used. MATERIALS AND METHODS This retrospective descriptive study includes 366 patients with fractures of zygoma treated in the Department of Plastic Surgery at Gandhi Medical College between the years 2008-2017. The history obtained, clinical examination and diagnostic tests done were analysed. Incidence, age, gender, site of fracture, side of fracture, aetiology and method of management and the outcome after surgery were the different variables analysed. RESULTS 366 patients with fractures of zygoma were analysed. There is a rise of incidence ranging from as low as 12.96% to as high as 62.50% of total fracture of faciomaxillary cases during the decade. Males were more frequently involved (88.79%) in comparison to females. The commonly involved age group was between 21-30 years (36.88%). Most of the patients sustained injuries due to road traffic accidents (78.14%). Body of the zygoma was involved in 33.33% of total cases of fracture zygoma cases. X-rays, digital x-rays and 3D computerised tomography were used as the diagnostic modalities. Open reduction and internal fixation with plate and screws was done in 50.27% of cases. Complications like wound infection, plate exposure were noted in 8.46% (31 out of 366 patients). CONCLUSION Road traffic accidents were found to be the common cause of fractures of the zygoma. Awareness regarding traffic rules and regulations and counselling youth regarding hazards of drunken driving, bike and car races on public roads should to be done. In young males, body of the zygoma was more commonly involved. Early intervention enabled good functional and aesthetic outcomes. Patients with restricted mouth opening can be attended to by either redo-ORIF or dilatations with Heister's dilator or by insertion of the ice cream sticks by increasing them progressively.

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Does C-Arm Guidance Improve Reduction of Zygomatic Arch Fractures?—A Randomized Controlled Trial

Cited by 15 publications

References 15 publications

Treatment of orbital fractures – a critical analysis of ophthalmic outcomes and scenarios for re-intervention

Treatment of orbital fractures – a critical analysis of ophthalmic outcomes and scenarios for re-intervention

Role of Plain Radiographs in Assessing Appropriate Placement of Orbital Implants for Repair of Floor Fractures

A Retrospective Descriptive Study of Epidemiology of Fractures of Zygoma in Tertiary Care Hospital Over a Period of a Decade

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