Improved Results in Closed Reduction of Zygomatic Arch Fractures by the Use of Intraoperative Cone-Beam Computed Tomography Imaging

Abstract

Purpose: The use of intraoperative imaging could help overcome the insufficiency of closed reduction that can result from the absence of visible feedback to evaluate the accuracy of the reduction in isolated zygomatic arch fractures. The aim of the present study was to evaluate the use of intraoperative 3-dimensional cone-beam computed tomography (CBCT) to improve the accuracy of reduction, by measuring the remaining cortical step and dislocation angle. We also evaluated the effect of CBCT on the need for repeat surgery.

Patients and methods: We performed a retrospective cohort study of patients who had undergone zygomatic arch reduction surgery from January 2008 to May 2018. The patients were grouped according to the predictor variables into group A (postoperative radiologic follow-up studies) and group B (intraoperative CBCT imaging studies). The primary outcome variables were the remaining cortical step and dislocation angle compared with the ideal virtually mirrored position. These were assessed as measures of reduction accuracy. The secondary variables included age, gender, surgery duration, and fracture type. Statistical analysis was performed using a robust multiple regression analysis.

Results: The 45 patients were divided into 2 subgroups with 18 patients in the no intraoperative imaging (control) group and 27 patients in the intraoperative imaging group. Insufficient reduction occurred in 1 patient in the group without intraoperative imaging, leading to repeat surgery. No repeat surgery was necessary in the intraoperative imaging group. The remaining cortical step of the intraoperative imaging group was significantly lower than that of the control group (0.18 vs 2.03 mm; P < .001). For the remaining dislocation angle, similar findings were observed but without statistical significance (3.93° vs 7.75°; P = .58).

Conclusions: The use of intraoperative CBCT significantly increased the accuracy of the reduction. Furthermore, the need for repeat surgery was not required for any patient in the intraoperative imaging group with CBCT-guided reduction.