Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, No. 5 Fuxing St., Guishan District, Taoyuan City 333, Taiwan.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, 222 Maijin Road, Keelung 20401, Taiwan.
J Plast Reconstr Aesthet Surg. 2021 Feb;74(2):341-349. doi: 10.1016/j.bjps.2020.08.049. Epub 2020 Aug 25.
Secondary post-traumatic orbital reconstructions are challenging. Portable computed tomography (CT) provides the option to acquire real-time, intraoperative images that help to detect the insufficient reconstruction of the orbit immediately. We retrospectively analyzed patients who received intraoperative CT imaging and analyzed the effect of intraoperative CT scans on revision rates and orbital volume changes before, during, and after surgery.
From August 2014 to September 2016, eleven patients received intraoperative cone-beam CT scans to evaluate the results of secondary orbit reconstruction using Medpor + titanium implants. Patient demographics, surgical details, CT scanning protocol, and follow-up results were analyzed. 3D CT volumetry was used to analyze the orbital volume based on OsiriX MD software.
Based on intraoperative CT findings, seven cases required intraoperative revision to further augment the orbital cavity or adjust implants. The mean preoperative measured enophthalmos was 3.41±1.4 mm (range: 2-6 mm), which decreased to 0.73±0.4 mm (range: 0-1 mm) at postop assessment (p<0.0001). On the fracture side, there was a significant difference between preoperative vs. intraoperative and preoperative vs. postoperative volume measurements (p<0.01 for both subsets), but no significant difference between intraoperative vs. postoperative measurements.
Intraoperative CT is a valuable tool in secondary orbital reconstruction cases based on clinical enophthalmos evaluation and 3D CT volumetry. For these patients, the avoidance of another revision surgery may outweigh the disadvantage of increased operation time and additional radiation exposure.
继发性创伤后眶重建具有挑战性。便携式计算机断层扫描（CT）提供了获取实时术中图像的选项，有助于立即发现眶重建不足。我们回顾性分析了接受术中 CT 成像的患者，并分析了术中 CT 扫描对手术前后眶容积变化和修复率的影响。
2014 年 8 月至 2016 年 9 月，11 例患者接受术中锥形束 CT 扫描，以评估使用 Medpor + 钛植入物进行继发性眶重建的结果。分析了患者的人口统计学资料、手术细节、CT 扫描方案和随访结果。使用 3D CT 体绘制法基于 OsiriX MD 软件分析眶容积。
根据术中 CT 结果，7 例需要术中修正，以进一步扩大眶腔或调整植入物。术前测量的眼球内陷平均值为 3.41±1.4mm（范围：2-6mm），术后评估降至 0.73±0.4mm（范围：0-1mm）（p<0.0001）。在骨折侧，术前与术中、术前与术后容积测量值之间存在显著差异（两个子集均为 p<0.01），但术中与术后测量值之间无显著差异。
根据临床眼球内陷评估和 3D CT 体绘制，术中 CT 是继发性眶重建病例的一种有价值的工具。对于这些患者，避免再次手术修复的好处可能超过手术时间延长和额外辐射暴露的缺点。
