Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, Besançon Cedex 25030, France; INSERM, EFS BFC, UMR1098, Host-Graft Interactions/Cell and Gene Engineering, University of Bourgogne Franche-Comté, Besançon 25000, France.
Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, Besançon Cedex 25030, France; INSERM, EFS BFC, UMR1098, Host-Graft Interactions/Cell and Gene Engineering, University of Bourgogne Franche-Comté, Besançon 25000, France.
J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e576-e580. doi: 10.1016/j.jormas.2022.03.007. Epub 2022 Mar 5.
Orbital floor fracture (OFF) are frequently associated with zygomatic fractures (ZF). The reduction of the ZF may modify the features of the associated OFF. Intraoperative cone beam CT (CBCT) has shown diagnostic performance of OFF. The aim of our study was to evaluate how intraoperative CBCT control made after the reduction of ZF may help to take a decision on the associated OFF.
Patients with a unilateral displaced ZF associated with an OFF were consecutively included during a 3-year period. Intraoperative CBCT, systematically performed after reduction of the ZF, allowed to decide if the OFF needed reconstruction. The preoperative estimation made on MDCT and the intraoperative decision regarding the OFF were compared.
Fifty-nine consecutive patients could be included in the study. Nineteen OFF were presumed to be surgical indications on the preoperative MDCT but only 16 indications were confirmed on the intraoperative CBCT, meaning that 3 OFF behaved favorably during the ZF reduction. Forty orbital floor fractures were presumed to be non-surgical on the preoperative MDCT but 6 of them worsened during ZF reduction and became surgical indications. Overall, the intraoperative CBCT control had an impact on 9 (15.3%) of the OFF.
Our study showed that OFF after ZF reduction may evolve favorably or, on the contrary, get worse in 15% of the cases. Surgical indication on an OFF can therefore be confirmed intraoperatively. This allows to avoid under-treatment in the patients where the OFF worsens after ZF reduction and over-treatment in the patient where the OFF reduces after ZF.
眼眶地板骨折（OFF）常与颧骨骨折（ZF）相关。ZF 的复位可能会改变相关 OFF 的特征。术中锥形束 CT（CBCT）已显示出 OFF 的诊断性能。我们的研究目的是评估 ZF 复位后进行的术中 CBCT 控制如何有助于对相关 OFF 做出决策。
在 3 年期间，连续纳入单侧移位 ZF 伴 OFF 的患者。在 ZF 复位后系统进行的术中 CBCT 允许决定是否需要重建 OFF。将术前 MDCT 上的估计与术中关于 OFF 的决策进行比较。
59 例连续患者可纳入研究。19 例 OFF 术前 MDCT 被认为是手术指征，但仅 16 例在术中 CBCT 上得到证实，这意味着 3 例 OFF 在 ZF 复位过程中表现良好。40 例眼眶地板骨折术前 MDCT 被认为是非手术指征，但其中 6 例在 ZF 复位过程中恶化，成为手术指征。总体而言，术中 CBCT 控制对 9 例（15.3%）OFF 有影响。
我们的研究表明，ZF 复位后 OFF 可能会好转，也可能在 15%的情况下恶化。因此，OFF 的手术指征可以在术中得到证实。这可以避免在 ZF 复位后 OFF 恶化的患者中治疗不足，以及在 ZF 复位后 OFF 减轻的患者中治疗过度。
