Benedetti Simone, Frosolini Andrea, Cascino Flavia, Pignataro Laura Viola, Franz Leonardo, Marioni Gino, Gabriele Guido, Gennaro Paolo
Maxillofacial Surgery Unit, Department of Medical Biotechnology, S. Maria alle Scotte University Hospital of Siena, 53100 Siena, Italy.
Phoniatrics and Audiology Unit, Department of Neuroscience DNS, Univeristy of Padova, 31100 Treviso, Italy.
Tomography. 2025 Feb 18;11(2):19. doi: 10.3390/tomography11020019.
Zygomatico-maxillary complex (ZMC) fractures are prevalent facial injuries with significant functional and aesthetic implications. Computer-assisted surgery (CAS) offers precise surgical planning and outcome evaluation. The study aimed to evaluate the application of CAS in the analysis of ZMC fracture outcomes and to propose a reproducible workflow for surgical outcome assessment using cephalometric landmarks.
A retrospective cohort study was conducted on 16 patients treated for unilateral ZMC fractures at the Maxillofacial Surgery Unit of Siena University Hospital (2017-2024). Inclusion criteria included ZMC fractures classified as Zingg B or C, treated via open reduction and internal fixation (ORIF). Pre- and post-operative CT scans were processed for two- and three-dimensional analyses. Discrepancies between CAS-optimized reduction and achieved surgical outcomes were quantified using cephalometric landmarks and volumetric assessments.
Out of the 16 patients (69% male, mean age 48.1 years), fractures were predominantly on the right side (81%). CAS comparison between the post-operative and the contralateral side revealed significant asymmetries along the X and Y axes, particularly in the fronto-zygomatic suture (FZS), zygo-maxillary point (MP), and zygo-temporal point (ZT). Computer-assisted comparison between the post-operative and the CAS-simulated reductions showed statistical differences along all three orthonormal axes, highlighting the challenges in achieving ideal symmetry despite advanced surgical techniques. CAS-optimized reductions demonstrated measurable improvements compared to traditional methods, underscoring their utility in outcome evaluation.
CAS technology enhances the precision of ZMC fracture outcome evaluation, allowing for detailed comparison between surgical outcomes and virtual simulations. Its application underscores the potential for improved surgical planning and execution, especially in complex cases. Future studies should focus on expanding sample size, refining workflows, and integrating artificial intelligence to automate processes for broader clinical applicability.
颧上颌复合体（ZMC）骨折是常见的面部损伤，对功能和美观有重大影响。计算机辅助手术（CAS）可提供精确的手术规划和结果评估。本研究旨在评估CAS在ZMC骨折结果分析中的应用，并提出一种使用头影测量标志点进行手术结果评估的可重复工作流程。
对锡耶纳大学医院颌面外科治疗的16例单侧ZMC骨折患者进行回顾性队列研究（2017 - 2024年）。纳入标准包括分类为Zingg B或C型的ZMC骨折，采用切开复位内固定术（ORIF）治疗。对术前和术后的CT扫描进行二维和三维分析。使用头影测量标志点和容积评估来量化CAS优化复位与实际手术结果之间的差异。
16例患者中（69%为男性，平均年龄48.1岁），骨折主要发生在右侧（81%）。术后与对侧的CAS比较显示，沿X轴和Y轴存在明显不对称，特别是在额颧缝（FZS）、颧上颌点（MP）和颧颞点（ZT）。术后与CAS模拟复位之间的计算机辅助比较显示，沿所有三个正交轴均存在统计学差异，这突出了尽管采用了先进的手术技术，但实现理想对称仍存在挑战。与传统方法相比，CAS优化复位显示出可测量的改善，强调了其在结果评估中的实用性。
CAS技术提高了ZMC骨折结果评估的精度，允许对手术结果与虚拟模拟进行详细比较。其应用强调了改进手术规划和执行的潜力，特别是在复杂病例中。未来的研究应侧重于扩大样本量、完善工作流程以及整合人工智能以实现流程自动化，以提高临床适用性。
