gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Cone Beam tomography for intraoperative visualisation of complex midfacial and mandibular trauma: Indications, advantages and restrictions

Meeting Abstract

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  • Joachim Polligkeit - Universitätsklinikum Tübingen, Klinik u. Poliklinik für MKG-Chirurgie, Tübingen
  • Marcel N. Cetindis - Universitätsklinikum Tübingen, Klinik u. Poliklinik für MKG-Chirurgie, Tübingen
  • Siegmar Reinert - Universitätsklinikum Tübingen, Klinik u. Poliklinik für MKG-Chirurgie, Tübingen

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch207

DOI: 10.3205/12dgch207, URN: urn:nbn:de:0183-12dgch2079

Veröffentlicht: 23. April 2012

© 2012 Polligkeit et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Midfacial fractures are often associated with changes in dental occlusion. In surgery, occlusion is restored by maxillomandibular fixation, taking the mandibular position as a reference for assumed preoperative occlusion. However, in complex panfacial trauma this proceeding is difficult, possibly resulting in an incorrect transversal dimension of the upper jaw due to a broadened mandibular arch. LeFort-II-Fractures and zygomatic bone fractures are always associated with adjacent orbital floor fractures. Discussed controversely, in many cases of these fractures without ophthalmologic symptoms, routinely performed orbital floor exploration is not indicated. Postoperative realignment of the orbital floor is achieved by repositioning of the maxillary/zygomatic bone alone if there is an intact periorbita, i.e. if periosteal sheeting of the orbital floor is preserved.

Materials and methods: We retrospectively analysed exemplary cases with multi-fragmented mandibular fractures, Le-Fort-II fractures, isolated zygomatic bone fractures and panfacial fractures (combined mandibular and midfacial fractures). In all patients, intraoperative cone beam tomography for control and optimisation of surgery result was performed.

Results: Intraoperative cone beam tomography is a reliable method for improvement of surgery result in special indications: a) dislocated or multi-fragmented mandibular fractures, b) panfacial fractures with severe occlusal changes and c) dislocated Le Fort-II and zygomatic bone fractures.

Conclusion: In patients with LeFort-II and zygomatic bone fractures, intraoperative cone beam tomography may redundantise orbital floor exploration. In consequence, complications attributed to lower lid approaches can be avoided. Intraoperative imaging also facilitates establishment of mandibular dental arch configuration. The original transversal dimension of the mandible is restored and may be taken as a reference for upper jaw position in combined, panfacial fractures. Further advantages of cone beam tomography are patient´s reduced exposure to radiation and a picture quality comparable with conventional CAT scans. In all patients with intraoperative imaging, there was no need for further postoperative CAT scan imaging.