Utilization of Intraoperative CT in Craniomaxillofacial Trauma Surgery

Publication date: Available online 13 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Karl Cuddy, Baber Khatib, R. Bryan Bell, Allen Cheng, Ashish Patel, Melissa Amundson, Eric J. Dierks
PurposeThe utilization of technology to aid in assessment, planning and management of complex craniomaxillofacial injuries is increasingly common. Pre-operative CT evaluation is considered standard of care and intraoperative imaging is becoming increasingly accessible. Limited data exists regarding the implication of intraoperative CT on decision making in management of all sites of facial fractures. The purpose of this study was to characterize the utilization of the 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 utilize this technology.MethodsThis retrospective case series characterizes the use of the 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, CT directed revision rate (overall and for specific pre-operative diagnoses) and the indication for imaging. This information was evaluated to provide guidance on appropriate utilization of an intraoperative scanner.ResultsA total of 161 patients were identified to have intraoperative facial CT scans from February 2011 to Sept 20, 2016 at Legacy Emanuel Medical Center. A total of 212 intraoperative facial CT scans were performed over 168 separate operations. The overall CT directed revision rate was 28%. CT directed revision rates for fracture sub-sites are listed as follows: orbital – 31%, ZMC - 24%, LeFort 1 – 8%, LeFort II and III - 23%, naso-orbital ethmoidal - 23%, mandible – 13%, frontal sinus 0%. No CT directed revisions were made during removal of hardware, placement of craniofacial implants or in TMJ replacement surgery.ConclusionIf available, intraoperative CT should be routinely considered in the operative management of orbital fractures, panfacial fractures as well as complex ZMC, LeFort II and III, and NOE fractures. Consideration should also be given for the utilization of intraoperative CT in cases of complex mandible fractures involving severe comminution or the condylar region. Intraoperative CT should not be routinely utilized for management of LeFort 1 fractures or frontal sinus fractures.



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