On the treatment of zygomaticomaxillary complex fractures: Intraoperative imaging

Abstract

Traffic accidents are the most common cause of maxillofacial fractures in the Dutch population. Therefore preventive measures aimed at decreasing the incidence of maxillofacial fractures are likely to be most efficacious if addressed at preventing maxillofacial injuries due to traffic accidents. In ZMC fractures treated without intraoperative imaging, comminuted fractures are associated with inferior treatment outcome. Intraoperative imaging often leads to treatment revisions aimed to improve either ZMC fracture reduction or orbital floor treatment, especially in comminuted ZMC fractures and in ZMC fractures in which treatment of the orbital floor is indicated. Treatment of ZMC fractures with intraoperative CBCT imaging leads to accurate fracture reduction. The relevance of the revisions after intraoperative imaging could not be confirmed statistically at group level in this thesis. However, a trend towards fewer secondary surgical interventions to improve ZMC position or the orbital floor treatment was observed in patients treated with intraoperative imaging (Chapter 6) in comparison to patients treated without intraoperative imaging (Chapter 3). The proposed method for measuring ZMC asymmetry with mirroring of the ZMC and surface-based matching on the anterior cranial fossa is reliable, accurate, and suitable for the evaluation of ZMC fractures.

Recommendation Based on the research in this thesis we recommend to use intraoperative imaging in ZMC fractures that are comminuted (C-type) and in ZMC fractures in which treatment of the orbital floor is indicated.