Page 86 - Advanced concepts in orbital wall fractures

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Chapter 5
Abstract
Purpose: Intraoperative imaging enables the surgeon to control the position of the implant during orbital reconstruction. Although it might improve surgical outcome and avoid the need for revision surgery, it may also increase the duration of the operation and the exposure to radiation. The goal of this study was to find out whether intraoperative imaging improves the position of the implant in reconstructions of the orbital floor and medial wall.
Materials and methods: Two surgeons reconstructed complex orbital fractures in ten cadavers. After the reconstruction a computed tomography scan was made to confirm the position of the implant and, if required, to make any adjustments. Scans were repeated until the surgeon was satisfied. The ideal position was ascertained by scans that were obtained before and after creation of the fractures. The position of the implant achieved was compared with that of the ideal position.
Results: The implant position improved significantly for yaw (p=0.04) and roll (p=0.03). A mean of 1.6 scans was required per reconstruction (maximum n=3). The main reason for alteration was the rotation roll.
Conclusion: Intraoperative imaging significantly improves the position of the implant fractures of the orbital floor and medial wall. The surgeon has quality control of its position during the reconstruction to restore the anatomical boundaries.