Korner Dominique, Schönegg Daphne, Wiedemeier Daniel, Wagner Maximilian Eberhard Hermann, Essig Harald, Blumer Michael
Doctoral Candidate, Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland.
Resident, Department of Cranio-Maxillo-Facial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
J Oral Maxillofac Surg. 2025 May;83(5):576-584. doi: 10.1016/j.joms.2025.01.013. Epub 2025 Jan 30.
Intraoperative cone-beam computed tomography (CBCT) during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures may facilitate the re-establishment of a complex 3-dimensional anatomy.
This study was conducted to measure the occurrence of malpositions after ZMC fracture reduction and intraoperative revision rates after conducting intraoperative CBCT.
STUDY DESIGN, SETTING, SAMPLE: This retrospective case series included subjects treated for ZMC fractures with intraoperative CBCT at the Department of Maxillofacial Surgery of the University Hospital Zurich (Switzerland) over a 5-year period (January 2015 to December 2019). The exclusion criteria were a history of facial fracture and incomplete data.
Not applicable.
The primary outcome variable was malpositioning after ZMC fracture reduction on intraoperative 3-dimensional imaging. Further variables-including intraoperative revisions of ZMC malpositions, osteosynthesis material revisions, and intraoperative assessments of orbital reconstruction-were analyzed.
Demographic (age and sex) and clinical (associated with facial fractures) characteristics were assessed.
The analyses included Spearman's rank correlations, mosaic plots, χ tests, and Fisher's exact tests. The confidence level for hypothesis testing was set at P < .05.
The sample included 337 subjects, and 589 intraoperative CBCT scans were obtained. ZMC malposition after reduction was observed in 154 (45.7%) subjects; the most common malpositions were caudal displacement, underprojection, and inward rotation of the ZMC. Intraoperative revisions were conducted in 150 (44.5%) subjects: 105 (31.2%) subjects exhibited a ZMC malposition, 13 (3.9%) subjects needed revisions of the osteosynthesis material placement, and 32 (9.5%) subjects required intraoperative orbital floor reconstruction. No secondary revision surgeries were required, excluding 25 secondary orbital floor reconstructions. Preoperative and intraoperative radiographic findings did not correlate regarding indications for orbital floor reconstruction.
The 44.5% intraoperative revision rate underscores the challenges of ZMC fracture surgery. Clinical evaluation of fracture reduction at the latero-orbital rim is recommended to identify caudal displacements, and intraoperative CBCT helps identify candidates for primary orbital floor reconstruction. This technique may enhance quality control and precision, thereby potentially improving patient outcomes.
颧骨上颌骨复合体（ZMC）骨折切开复位内固定术中的术中锥形束计算机断层扫描（CBCT）可能有助于重建复杂的三维解剖结构。
本研究旨在测量ZMC骨折复位后错位的发生率以及进行术中CBCT后的术中翻修率。
研究设计、设置、样本：本回顾性病例系列包括在瑞士苏黎世大学医院颌面外科接受术中CBCT治疗的ZMC骨折患者，为期5年（2015年1月至2019年12月）。排除标准为面部骨折史和数据不完整。
不适用。
主要结局变量是术中三维成像显示的ZMC骨折复位后的错位情况。还分析了其他变量，包括ZMC错位的术中翻修、骨合成材料翻修以及眶重建的术中评估。
评估人口统计学（年龄和性别）和临床（与面部骨折相关）特征。
分析包括Spearman等级相关性、镶嵌图、χ检验和Fisher精确检验。假设检验的置信水平设定为P < 0.05。
样本包括337名受试者，共获得589次术中CBCT扫描。154名（45.7%）受试者复位后出现ZMC错位；最常见的错位是ZMC的尾端移位、投影不足和向内旋转。150名（44.5%）受试者进行了术中翻修：105名（31.2%）受试者存在ZMC错位，13名（3.9%）受试者需要对骨合成材料放置进行翻修，32名（9.5%）受试者需要术中眶底重建。除25例二次眶底重建外，无需二次翻修手术。术前和术中影像学检查结果在眶底重建指征方面无相关性。
44.5%的术中翻修率凸显了ZMC骨折手术的挑战。建议对眶外侧缘骨折复位进行临床评估以识别尾端移位，术中CBCT有助于识别初次眶底重建的候选者。该技术可加强质量控制和精度，从而可能改善患者预后。
