Management Of Orbital Fractures Research Articles

Assessing the accuracy of artificial intelligence in the diagnosis and management of orbital fractures. Is this the future of surgical decision-making?

Orbital fractures are common, but their management remains controversial. The aim of the present study is to assess the accuracy of an advanced artificial intelligence (AI) model, ChatGPT-4, in surgical decision-making, with a focus on orbital fracture diagnosis and management. A retrospective observational analysis was conducted, involving a sample of thirty orbital fracture cases diagnosed and managed at the Geneva University Hospital, Switzerland. The process involved creating patient vignettes from anonymised medical records and presenting them to ChatGPT-4 in three stages: initial diagnosis, refinement with radiological reports, and surgical intervention decisions. The performance of ChatGPT-4 in providing the appropriate surgical strategy was evaluated through measures of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), with the actual management used as the benchmark for accuracy. The AI model was able to correctly diagnose the fracture in 100% of cases. It demonstrated a specificity of 100%, and a sensitivity of 57% for treatment recommendation, indicating its effectiveness in recognizing patients truly requiring an intervention, however a moderate performance in correctly identifying cases better suited for conservative treatment. Cohen's Kappa statistic for interrater reliability of choice of treatment is 0.44, indicating a weak level of agreement between ChatGPT and the physician's actual choice of treatment. The study demonstrates that AI tools such as ChatGPT-4 can offer a high degree of accuracy for the diagnosis of orbital fractures, and in the recognition of patients requiring surgical intervention, however, it performs less well in correctly identifying patients better suited for non-surgical treatment.

Reconstruction Management for Neglected Tripod Fracture with Ophthalmic Injuries: A Case report

Introduction : Tripod fracture or zygomatico-maxillary complex fracture are among the most common injuries to facial structures, which can make reconstruction more difficult. This case highlights the reconstruction of neglected tripod fracture.
 Case Illustration : A 17-year-old male was presented with enophthalmos in his right eye. He had an accident three months prior and had received head surgery. After that, the patient came back with a pan-facial fracture. VA on RE was 1/300, limited movement upwards, 4 mm lagophthalmos, negative Bell’s phenomenon, infiltrates and cicatrices on the cornea. CT-scan examination showed tripod fractures. The surgery was performed by the reconstruction division with an oral and maxillofacial surgeon. Nineteen days after surgery, there has been some improvement in the orbital misalignment.
 Discussion : Delayed intervention in this case, increased the difficulty of surgical treatment and could lower the success rate of surgery. If the indication is obvious, an immediate intervention will give better results because soft tissue scarring is minimized and fractures are easily reduced. During the procedure, we released the orbital muscle entrapment and repaired the deviated bone and callus with an osteotome to achieve mobility. Therefore, the tripod fracture was fixed with three-point fixation, followed by reconstruction of the maxilla and mandible. The result after surgery showed some improvements in aesthetics but not in vision.
 Conclusion : Orbital reconstruction with mini-plate implants in three-point fixation as the management of orbital fractures is effective, but its accuracy is difficult to assess during surgery, especially when coupled with delayed intervention cases. Early reconstruction is recommended for a better cosmetic result.

Augmented and Virtual Reality for Preoperative Trauma Planning, Focusing on Orbital Reconstructions: A Systematic Review.

This systematic review summarizes recent literature on the use of extended reality, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), in preoperative planning for orbital fractures. A systematic search was conducted in PubMed, Embase, Web of Science and Cochrane on 6 April 2023. The included studies compared extended reality with conventional planning techniques, focusing on computer-aided surgical simulation based on Computed Tomography data, patient-specific implants (PSIs), fracture reconstruction of the orbital complex, and the use of extended reality. Outcomes analyzed were technical accuracy, planning time, operative time, complications, total cost, and educational benefits. A total of 6381 articles were identified. Four articles discussed the educational use of VR, while one clinical prospective study examined AR for assisting orbital fracture management. AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time. Consequently, intraoperative imaging enhancement helps to guide the orientation of the orbital reconstruction plate and better visualize the precise positioning and fixation of the PSI of the fractured orbital walls. However, the technical accuracy of 2-3 mm should be considered. VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.

Virtual Planning and 3D Printing in the Management of Acute Orbital Fractures and Post-Traumatic Deformities.

Virtual surgical planning (VSP) and three-dimensional (3D) printing have advanced surgical reconstruction of orbital defects. Individualized 3D models of patients' orbital bony and soft tissues provide the surgeon with corrected orbital volume based on normalized anatomy, precise location of critical structures, and when needed a better visualization of the defect or altered anatomy that are paramount in preoperative planning. The use of 3D models preoperatively allows surgeons to improve the accuracy and safety of reconstruction, reduces intraoperative time, and most importantly lowers the rate of common postoperative complications, including over- or undercontouring of plates, orbital implant malposition, enophthalmos, and hypoglobus. As 3D printers and materials become more accessible and cheaper, the utility of printing patient-specific implants becomes more feasible. This article summarizes the traditional surgical management of orbital fractures and reviews advances in VSP and 3D printing in this field. It also discusses the use of in-house (point-of-care) VSP and 3D printing to further advance care of acute orbital trauma and posttraumatic deformities.

P-66118405-104 - Isolated paediatric orbital fractures: A case series at a major trauma center.

<h3>Purpose</h3> Paediatric orbital fractures are rare. The existing literature demonstrates wide variation in estimates of incidence, aetiology, management protocols and outcomes. Despite this, it is generally acknowledged that orbital fractures with entrapment of the extraocular muscles constitute a surgical emergency due to the potential for persistent diplopia secondary to muscle ischaemia and necrosis. <h3>Methods</h3> This was a retrospective study, conducted to determine the characteristics and outcomes of management of orbital fractures amongst the paediatric population. It involved patients presenting to King's College Hospital, London between 2010-2020. <h3>Results</h3> 20 patients with pure orbital fractures presented to our Unit in this period. The average age of the patients was 11 years with a male preponderance. The predominant aetiology was road traffic accidents, but in surgical patients aged 13 to 16 this was interpersonal violence. The most common fracture pattern involved the orbital floor and medial wall. 9 patients required surgical intervention due to diplopia caused by entrapment of extraocular muscles. 5 patients had nausea, vomiting or bradycardia associated with the occulocardiac reflex. Surgical intervention occurred within 24 - 48hours of the patient sustaining their injury in 6 cases. Resorbable sheet was used to reconstruct the orbit. Resolution of diplopia occurred in 7 patients within 6 months. Length of follow up ranged from 1 to 18 months. <h3>Conclusions</h3> Paediatric patients with orbital fractures should be assessed on the day of injury by a maxillofacial surgeon. Due to the risk of persistent diplopia, urgent surgical intervention in patients with entrapment of extraocular muscles should occur as soon as possible.

Clinical application of automated virtual orbital reconstruction for orbital fracture management with patient-specific implants: A prospective comparative study

The aim of the study was to compare automated and manually conducted (slice-by-slice) virtual orbital wall reconstruction in terms of PSI design, manufacture, and clinical application for orbital fracture management.Patients with orbital wall fractures were evaluated for the potential for treatment with PSI, based on automated virtual wall reconstruction; these formed the main group. The surgical outcomes of these main-group patients' treatments were compared with those of the control group, which comprised patients randomly selected for this study, each of whom had the same orbital trauma patterns and were also managed with PSI. However, the control group patients were treated using ‘slice-by-slice’ virtual orbital reconstruction.Mean volume differences between the intact and reconstructed orbit were 0.65 ± 0.26 cm3 in the main group (n = 23) and 0.57 ± 0.23 cm3 in the control (n = 27; p = 0.837). In both groups, no cases of implant malposition or enophthalmos were detected after surgery. Orbital shape difference was similar for the main group and the control, at −3.3 ± 3.5% and 3.25 ± 2.5%, respectively (p = 0.929). Diplopia was diagnosed at the 3-month follow-up in 13.0% of the main group and in 11.1% of the control (p = 0.651). The average times spent on computer-aided design (CAD) procedures, including segmentation, virtual orbital reconstruction, and PSI design, were 36.7 ± 6.9 min in the main group and 72.9 ± 7.7 min in the control group (p < 0.001).Within the limitations of the study it seems that PSI based on automated virtual reconstruction is a relevant alternative treatment option for orbital fractures because of its clinical efficacy that is similar to PSI based on a ‘slice-by-slice’ CAD protocol.

Analysis of Readmission and Complications After Repair of Orbital Fractures Using California's Office of Statewide Health Planning and Development Database.

Orbital fractures represent one of the most common trauma-related facial fractures and may present with a variety of concomitant injuries. Many factors including age, associated diagnoses, and fracture complications are important in determining surgical candidacy. We used a statewide database to determine the prevalence of orbital fractures, rates of surgical repair during initial admission, and early patient outcomes. A longitudinal analysis of patients with orbital fracture was performed using California's Office of Statewide Health Planning and Development patient discharge database for admissions occurring between January 2015 and December 2018.Patients were identified using International Classification of Diseases, Tenth Revision codes. The primary risk factor was surgical management of orbital fractures. The primary outcomes of interest were readmission requiring surgical management and complications of the fracture. Survival models were developed to evaluate the risk of a repair at readmission adjusting for relevant covariates. Of the 67,408 facial fractures included in our study, 8.7% (n = 5872) were diagnosed with orbital fractures. Among this population, 18.4% (n = 1082) underwent surgical repair during their initial admission. Patients were primarily male (71.1%; n = 4,173) and presented in a nonurgent fashion (93.7%; n = 5501). Less than half (42.8%) of patients with an urgent presentation and 16.8% of patients with a nonurgent presentation underwent repair. Centers of Medicaid & Medicare Services guidelines dictated presentation classification. Repair was associated with a significantly higher survival outcome. Orbital fractures were more frequently repaired in the setting of concomitant zygomatic, nasal, and LeFort I-III fractures. Increased risk in complications was observed in all concomitant fracture groups, and there existed a decreased risk of postsurgical complications in these same cohorts. Although most orbital fractures were managed nonoperatively, our analysis found that rates of repair for orbital floor, maxillary, and zygomatic fractures were greater than for other facial fractures. Concomitant fractures were associated with an increased hazard ratio for complications. Although low in prevalence overall, the most often observed postoperative complications in this population were diplopia, glaucoma, and blindness/low vision.

Isolated paediatric orbital fractures: a case series and review of management at a major trauma centre in the UK.

PurposePaediatric orbital fractures are rare. Existing literature demonstrates wide variation in estimates of incidence, aetiology, management protocols and outcomes. Despite this, it is generally acknowledged that orbital fractures with entrapment of the extraocular muscles constitute a surgical emergency due to the potential for persistent diplopia secondary to muscle ischaemia and necrosis.MethodsThis retrospective study was conducted to determine the characteristics and outcomes of management of orbital fractures amongst the paediatric population. It involved patients presenting to a major trauma unit in London between 2010 and 2020.ResultsThirteen patients with isolated orbital fractures presented to our unit in this period. The average age was 13 years. Surprisingly the predominant aetiology was interpersonal violence. The most common fracture pattern involved the orbital floor and medial wall. One medial wall fracture case was missed in the emergency department.Eight patients required surgical intervention due to diplopia caused by muscular entrapment of extraocular muscles; the final patient had a large defect resulting in enophthalmos requiring a large titanium plate. A transconjuctival approach was preferred for surgical access and resorbable sheet was used in the remaining cases. Five patients had nausea, vomiting or bradycardia associated with the oculocardiac reflex. Surgical intervention occurred within 24–48 h of injury in 6 cases. Resolution of diplopia occurred in 7 patients within 6 months.ConclusionPaediatric patients with orbital fractures should be assessed on the day of injury by a maxillofacial surgeon. Due to the risk of persistent diplopia, urgent surgical intervention in patients with entrapment of extraocular muscles should occur as soon as possible.

Predictors of Delayed Enophthalmos After Orbital Fractures: A Systematic Review.

Background: Orbital fractures are a commonly encountered problem with 7-10% of patients developing delayed enophthalmos when managed conservatively with observation. Objective: To characterize the literature regarding incidence of delayed enophthalmos among patients with untreated unilateral isolated orbital wall fractures and determine what factors may predict this untoward outcome. Materials and Methods: Preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines were adhered to and a literature search was conducted using multiple medical subject headings (MeSH) headings. The publications were screened by two independent reviewers using the Critical Appraisal Skills Program (CASP) checklist and National Institute for Health and Clinical Excellence (NICE) quality assessment tools. Results: Sixteen articles met criteria for inclusion in the study. The systematic review showed five factors that may affect development of delayed enophthalmos: linear measurements, involvement of specific intraorbital structures, rounding of the inferior rectus muscle, orbital fracture area, and volumetric analysis stratified by fracture site. Conclusion: There is a paucity of level I and II evidence driving the current management of orbital fractures that may lead to delayed enophthalmos. Additional prospective trials are needed to build upon the existing literature to improve the quality of care for this patient population.

Improving Clinical Outcomes of Orbital Volume Restoration Using Peri-Operative Diagnostic Tools in Management of Orbital Fractures - A Prospective Study

Introduction: Accurate evaluation of change in orbital volume occurring due to trauma is of paramount importance to achieve an optimal final outcome. Thus, the purpose of this study was to assess and evaluate the orbital volume both radiological and clinical means for accurate surgical correction. Aim: To assess the final surgical outcome using standardized clinical and radiological tools perioperatively to restore orbital volume in patients with orbital wall fractures. Materials and Methods: A prospective interventional study of patients with unilateral orbital wall fractures which was carried out for 24 months. A thorough clinical evaluation and ophthalmological assessments including visual acuity, field of vision was performed. All patients had HRCT for volumetric assessment and assessed clinically for enophthalmos using Hertel exophthalmometer. Based on the level of enophthalmos and orbital volume change, treatment plan was formulated. Intraoperatively Hertel exophthalmometer is used to correct the predetermined enophthalmos. Postoperatively the patients are followed-up at designated intervals to assess the surgical outcome. RESULT: Road Traffic Accident (RTA) was the common etiology of orbital fractures which accounts for 84.1% (n=53) and the most common clinical sign was enophthalmos which accounted for 76.2% (n=48). The mean and standard deviation of orbital volume is 35.20 ± 4.21 and change in orbital volume is 4.29±2.76. The mean and standard deviation were calculated for all patients in different time intervals. The result showed a statistically significant difference in pre-operative phase, intra-operative phase and it maintained throughout the postoperative phase. CONCLUSION: In our study we have found that meticulous preoperative and intraoperative tools to assess in orbital reconstruction gives a desired surgical outcome. Hertel exophthalmometer and HRCT based 3D reconstructed volumetric analysis can be an excellent tool to evaluate anteroposterior globe malposition and volume change.

Management of orbital fractures in adolescents. Review and case report of three different techniques

The management of orbital fractures in children and adolescents is little reported in the literature, considering that orbital fractures can cause functional problems such as enophthalmia, diplopia and aesthetic deformities. The aim of this study is to review the literature and report three clinical cases, corroborating with professional experience, about the different management of orbital fractures in adolescents, approaching the advantages, disadvantages and complications. Among the different fractures of the orbital floor, the techniques of interposition of autograft of the anterior wall of the maxillary sinus, suture for anchoring the periosteum, and reduction and stabilization of the fracture by means of titanium mesh fixation were performed. The choice of material and technique depends on the surgeon's preference, access and availability of materials. Regardless of which technique and material is used, and complete removal of the herniated tissue is fundamental to obtain satisfactory results.

Surgical Management of Orbital Fractures Using X-ray Film Plate: a Retrospective Case Series

Purpose: Orbital trauma is associated with orbital blowout fractures, with associated globe injuries and loss of vision. Orbital reconstruction can be done with various implant materials. The aim of this study is to identify the safety and postoperative outcomes of using X-ray films as orbital implants during orbital reconstruction surgery.&#x0D; Study Design: An interventional case series.&#x0D; Place and Duration of Study: Ophthalmology departments of Lahore General Hospital and Mayo Hospital, Lahore from June 2001 to May 2017.&#x0D; Methods: Retrospective data of all the patients who came for orbital reconstruction surgeries from June 2001 to May 2017 was retrieved. All patients had undergone CT scan prior to surgery. Orbital reconstruction was done by a single surgeon, by bridging bony defect with sterilized X-ray film. All patients received post-operative antibiotics for 1 week.&#x0D; Results: Twenty three male patients were included in the series, with a mean age of 28 ± 2.47 years. Assault and sports injuries with a ball were the commonest form of trauma. Diplopia was the major presenting complaint in 91% of the patients. All patients underwent surgical reconstruction of the orbital floor of orbit with sterilized X-ray film using a lateral canthotomy approach. Only mild postoperative diplopia was recorded in 7 of the cases, with uneventful recovery in the majority.&#x0D; Conclusion: Sterilized X-ray film is a safe, cost effective, and durable material for reconstruction after orbital blowout fracture, especially in developing countries.&#x0D; Key Words: Orbital fracture, X-ray film, Diplopia.

Review of orbital fractures in an urban level I trauma center

Purpose Orbital fractures are not uncommonly encountered in a level I trauma center. The incidence of adult orbital fractures in the United States is 10% to 25% among all facial fracture cases. Craniomaxillofacial trauma is typically managed by 3 different surgical specialties (Oral & Maxillofacial Surgery [OMFS], Otolaryngology [ENT], and Plastic & Reconstruction Surgery [PRS]). The purpose of our study was to understand the patterns and mechanisms of injury associated with orbital fractures and to develop standardized treatment protocols across all surgical specialties. Methods This was a retrospective chart review of patients who sustained orbital fractures that were surgically repaired at the Emory University Grady Memorial Hospital (GMH) between January 2012 and December 2016. The study inclusion criteria were (1) diagnosis of an orbital floor fracture, (2) age 18 years and greater, (3) treatment provided at the GMH by the craniomaxillofacial trauma team. Exclusion criteria were patient age less than 18 years and absence of surgical intervention. The predictor variables were (1) demographic characteristics, (2) injury detail, (3) involvement of other facial fractures, and (4) treatment variables. Patients were deidentified before data analysis. Statistical analysis was performed with χ2, Mann-Whitney U, and Kruskal-Wallis tests. Analyses were performed with the SPSS software (SPSS Inc., Chicago, IL), and P value of Results The initial chart review yielded 689 patients. Of these, 173 patients had been diagnosed with orbital fractures and met the inclusion criteria. The average patient age was 41.6 years, and most were males, with a male-to-female ratio of 3.3:1. Most fractures were caused by assault (39.3%), and 22.5% of the cases were bilateral. The left orbit was fractured more often than the right (40.5%). The orbital floor was the most common anatomic location (97.1%), and the maxilla was the most commonly involved bone (65.3%). The average time from consultation to surgical intervention was 8.7 ± 14.6 days, and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision was the most commonly used incision (63%), and the nonresorbable implant was the most commonly used implant (92.7%). Finally, the length of stay for simple orbital fractures was less than that for complex orbital fractures, with 1.5 days and 5.9 days, respectively. Conclusions Among the 3 major specialties (OMFS, PRS, ENT), there is no consensus with regard to the management of orbital fractures. Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for the uniformly high quality of surgical care for patients with maxillofacial fractures.

Orbital fracture management: The unclaimed domain of Oculoplasty

Orbital fracture management: The unclaimed domain of Oculoplasty - IJOOO- Print ISSN No: - 2581-5024 Online ISSN No:- 2581-5016 Article DOI No:- 10.18231/2455-8478.2018.0002, IP International Journal of Ocular Oncology and Oculoplasty-IP Int J Ocul Oncol Oculoplasty

Orbital Observation Chart: Significant in Orbital Fractures or Not?

The study was conducted to assess the efficacy of orbital chart in detecting postoperative complications of orbital fractures. A retrospective study was conducted in the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2011 to December 2016. It included all the patients with orbital fractures who underwent surgical intervention for reduction of the fracture in the study. We recorded data for the type of fracture, type of intervention, and orbital and ocular changes. Orbital changes measured and charted for 5 parameters which were: pain, proptosis, visual acuity, size of the pupil, and pupillary reaction to direct light reflex. Two hundred thirty-six patients with orbital fractures underwent surgical intervention during these 5 years. The prevailing type of fracture for which they required orbital intervention remains zygomatic complex fractures (69%). The treatment protocol depended on the pattern and displacement of fracture and age of the patient. Pain was the most common symptom among these parameters (15.7%). Orbital chart monitoring represents a straightforward and effective method to detect any complications after surgical management of orbital fractures.

Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management.

To examine the incidence of intracapsular hemorrhage in orbital fracture repair with non-fixated nylon sheet implants. A retrospective chart review of 227 patients presenting from January 2013 to December 2016 for orbital fracture repair with nylon sheet implants. Of the 331 orbital fractures repaired over 4 years, a total of 227 met inclusion criteria. The average implant thickness was 0.38 mm and no implants were fixated. Four total implants (1.8%) were removed due to complications; one each secondary to exploration for ongoing postoperative diplopia, immediate post-operative orbital hemorrhage, a cystic mass anterior to the implant, and pain. There were no cases of intracapsular hemorrhage nor infection for any of the 227 patients over 4 years. To the authors knowledge, this represents the largest case series to date to assess the rate of intracapsular hemorrhage in non-fixated nylon sheet orbital implants. In the 227 cases reviewed over a 4-year period, there were no cases of intracapsular hemorrhage. This suggests a much lower complication rate than previously reported. PRéCIS: A case series of 227 patients who underwent orbital fracture repair with non-fixated nylon sheet implants.

Management of pediatric orbital wall fractures

ABSTRACTBackgraound: The purpose of this study was to review the clinical features of pediatric orbital wall fracture.Methods: The MEDLINE literature database was searched for English language articles containing the following keywords: “pediatric orbital wall fracture,” “pediatric orbital blow-out fracture,” “pediatric orbital trapdoor fracture,” “orbital floor fractures in children,” “orbital blow-out fractures in children,” and “orbital trapdoor fractures in children.” The authors critically evaluated the unique aspects of orbital wall fractures in children with regard to epidemiology, clinical presentation, surgical management, and outcomes.Results: Orbital wall fractures in children are less common compared with in adults. The pattern of orbital fracture changes as children age because of the ongoing evolution in pediatric facial skeletal anatomy. Although the management of pediatric orbital fractures continues to progress, a thorough clinical assessment with computed tomography scan imaging remains essential. Urgent surgical intervention is indicated in cases of entrapment or severe hypoglobus. Entrapment with oculocardiac reflex is common in white-eyed blow-out or trapdoor fractures. Otherwise, pediatric fractures can be treated conservatively with surveillance. A variety of autogenous and allogenic materials may be used to repair the fractured orbit.Conclusion: Adult treatment algorithms are often not ideal for the management of orbital fractures in children in major part due to differences in the maturing status of the craniofacial structures. A multidisciplinary approach that utilizes imaging studies, an awareness of occult extraocular muscle entrapment, and an emphasis on the findings on physical examination should be employed to diagnose and treat pediatric orbital floor fractures. These injuries can be grouped into two categories based on the status of inferior extraocular muscles, as follows: (1) entrapped or “trapdoor” floor fractures and (2) nonentrapped orbital floor fractures. The former requires earlier intervention.

Complex Orbital Fractures: Three-Dimensional Planning and Combined Surgical Approach.

Nowadays the development of diagnostic imaging, surgical techniques, alloplastic materials, and surgical instruments has made possible a more accurate management of orbital fractures. The aim of the present study was the management of orbital fractures and the solution of particular cases. The use of high-resolution computed tomography makes possible to gain a better understanding of the complex orbit anatomical structure. Also endoscopy is a valid alternative for medial orbital wall fractures treatment. It gives high control of the fracture site and its reduction. When this technology is combined with 3-dimensional (3D) reformatted images, it allows us to reconstruct more accurately the orbital defects. The authors present their experience in complex orbital fractures treated with the aim of the 3D navigation using a preformed orbital titanium plate. Endosopical approach was used to control plate positioning.

Use of Intraoperative Computed Tomography in Craniomaxillofacial Trauma Surgery

The use of technology to aid in assessment, planning, and management of complex craniomaxillofacial injuries is increasingly common. Preoperative computed tomography (CT) evaluation is considered the standard of care, and intraoperative imaging is becoming increasingly accessible. Limited data exist regarding the implication of intraoperative CT on decision making in the management of all sites of facial fractures. The purposes of this study were to characterize the use of an intraoperative CT scanner for craniomaxillofacial surgery within our institution, to quantify the effect of intraoperative CT on surgical decision making, and to attempt to provide guidance on when to use this technology. This retrospective case series characterizes the use of an intraoperative CT scanner for craniomaxillofacial trauma surgery at a level 1 trauma center in Portland, Oregon, from February 2011 to September 2016. We evaluated the following variables: the number of intraoperative CT scans performed for craniomaxillofacial surgery including the number of scans for each patient, the number of scans for each operative visit, the CT-directed revision rate (overall and for specific preoperative diagnoses), and the indication for imaging. This information was evaluated to provide guidance on appropriate use of an intraoperative scanner. A total of 161 patients were identified to have intraoperative facial CT scans from February 2011 to September 20, 2016, at Legacy Emanuel Medical Center. A total of 212 intraoperative facial CT scans were performed across 168 separate operations. The overall CT-directed revision rate was 28%. CT-directed revision rates for fracture subsites are as follows: orbital, 31%; zygomaticomaxillary complex, 24%; Le Fort I, 8%; Le Fort II and III, 23%; naso-orbital-ethmoidal, 23%; mandible, 13%; and frontal sinus, 0%. No CT-directed revisions were performed during removal of hardware, during placement of craniofacial implants, or in temporomandibular joint replacement surgery. If available, intraoperative CT should be routinely considered in the operative management of orbital fractures and pan-facial fractures, as well as complex zygomaticomaxillary complex, LeFort II and III, and naso-orbital-ethmoidal fractures.Consideration also should be given to the use of intraoperative CT in cases of complex mandible fractures involving severe comminution or the condylar region. Intraoperative CT should not be routinely used for the management of Le Fort I fractures or frontal sinus fractures.

Management of Orbital Fractures Using Intraoperative Navigational Surgery. a Prospective Case Series

Management of Orbital Fractures Using Intraoperative Navigational Surgery. a Prospective Case Series