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Robert B. Stanley, Jr, MD, DDS

Arch Facial Plast Surg. 1999;1:19-24.

Objective  To assess the practicality and potential benefits of intraoperative computed tomography using a mobile scanner in the operating room during repair of orbitozygomatic fractures.

Setting  Level I trauma center.

Design  Twenty-five patients undergoing open reduction of a unilateral displaced fracture of the zygoma and/or repair of a blow-out fracture of the orbit with cranial bone grafts were placed into a radiolucent head holder and interfaced with the mobile scanner. Spatial vectors were drawn on scans displayed on a computer monitor to allow intraoperative side-to-side comparison of the position of the malar prominences and orbital walls. Corrections of fracture reduction or bone graft position were made as indicated by the comparisons.

Results  All scans were accomplished without apparent contamination of the surgical field. Major revisions were performed, based on the scans, in 2 patients whose displaced, comminuted zygoma fractures had been initially reduced with wide exposure of all fracture sites. Minor revisions were performed in 3 patients with displaced but less severely comminuted fractures that had been reduced without exposure of all fracture sites. Bone grafts were repositioned within the orbit in 2 patients with large 2-wall blow-out fractures.

Conclusions  Intraoperative computed tomographic evaluation of the adequacy of repair of orbitozygomatic fractures is feasible with the mobile computed tomographic scanner. The scanner allows correction of discrepancies in position of the malar prominences and orbital walls at the time of acute repair, rather than during costly, more difficult delayed revisions. It may eliminate the need for direct visualization of all fracture sites to ensure adequate reduction in selected cases with displaced, comminuted fractures, thus decreasing operating room time and expense. Further study is required to fully document the cost-effectiveness of this approach to facial fracture management.

From the Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle.

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