Intraoperative Computed Tomography Scan for Orbital Fracture Reconstruction

Abstract

Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.

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“…O-arm intraoperative CT as one of computer-assisted components in OBFs reconstruction has led to a positive change in operative management, even in our small series, as described above. This further emphasises the usefulness of this surgical tool in optimising orbital fracture repair and is in accordance with previous studies (Borad et al, 2017;Cannizzaro et al, 2017;van Hout et al, 2014, Nazimi et al, 2019a. From two-dimensional to three-dimensional images, the use of image fusion techniques could further enhance the potential of intraoperative CT imaging and has more to offer for primary delayed or for secondary OBFs reconstruction (Zizelmann et al, 2007;Heiland et al, 2004;2005).…”

“…Currently, it may also not be readily available for many institutions, with costs and/or the amount of radiation exposure as primary concerns. In recent publications, intraoperative CT has been regarded as an essential tool for the facial reconstructive surgeon in optimising surgical repair (Borad et al, 2017;Nazimi et al, 2019a). The use of intraoperative CT with O-arm also suggested that the imaging led to a significant change in operative management (Borad et al, 2017).…”

“…Computerassisted techniques have been extensively described and have been proven beneficial not only for diagnostic purposes but also for its surgical management. The techniques include the use of pre-surgical computer planning (Jansen et al, 2018), intraoperative navigation (Shin et al, 2016;He et al, 2020), customised implant solutions (Lim et al, 2015) for true-to-original reconstructions (Schön et al, 2006) and intraoperative computed tomography (CT) scanning (Borad et al, 2017;Nazimi et al, 2019a). In addition, intraoperative CT has been described not only in maxillofacial surgical applications, such as in the management of zygomatic complex fracture (Cannizzaro et al, 2017;van Hout et al, 2014) and its concomitant orbital blowout fracture (Borad et al, 2017) but also in various others neurosurgical (Schichor et al, 2017) and orthopaedic surgical (Scarone et al, 2018) procedures.…”

“…In OBFs reconstruction, it was recently shown that intraoperative CT allows intraoperative evaluation of surgical repair, including orbital plate repositioning, orbital plate dimension and helping the surgeon to decide whether orbital exploration is required (Borad et al, 2017). Similarly, the study suggested that CT imaging served as a valuable tool in optimising orbital fracture repair and decreasing the dependency towards the need for postoperative CT scanning (Borad et al, 2017;Nazimi et al, 2019a).…”

Reconstruction of Two Wall Orbital Fractures: Experience With the 3D Titan Implant and Intraoperative Computed Tomography

“…We attribute this to the use of intraoperative CT, which allows for precise anatomic positioning of the implant. As shown by Nazimi et al 21 the use of intraoperative CT allows for real-time assessment of fracture reduction and immediate implant orbital revision, circumventing the need for postoperative imaging. To the authors’ knowledge there have been no studies reported on the outcomes of the 3D titan implant and use of intraoperative CT for two-wall orbital reconstruction.…”