Page 95 - Advanced concepts in orbital wall fractures

intraoperative imaging is available, the positions of up to 50 % of the implants are altered. Schlittler et al. evaluated the position of the implant on the postoperative scans and only 45 % of the implants were in a good position with restoration of the orbital contours24. A total of 23 % were in a poor position and in 17 % revision surgery was necessary. Over 50 % of the patients might have benefited from intraoperative imaging and revision surgery could have been prevented in some patients.
In our study the CT scans were made with a fixed CT scanner instead of a mobile three-dimensional (3D) C-arm. This improved the quality of the images slightly, but we did not expect that this would have influenced the results. The 3D C-arms produce high quality images nowadays and shows sufficient detail.
A cadaveric study is not completely comparable to reality. The absence
of blood and limited soft tissue prolapse improves visibility, but this is C partially undone by the increased rigidity of the skin. The improved 5 visibility is underlined by the fact that there is no implant positioned
below the posterior ledge, whilst this occasionally happens in patients.
The advantage of a cadaver study is that the fractures were similar for
both observers.
It remains to be seen whether the significant differences in the position of the implants actually result in clinical improvement. The loss of bony orbital support does not necessarily encourage enophthalmus to develop, partly because soft tissue factors have an important role. Nevertheless, the surgeon should consider using an intraoperative scanner when reconstruction of the orbital floor or medial wall is planned. There is limited extra radiation and operating time, yet it enables the surgeon to correct large deviations and make minimal adjustments for the optimal position of the implant.
We therefore believe intraoperative imaging has the benefit of intraoperative quality control, give direct feedback to the surgeon, and could prevent revision surgery. Additionally, preoperative virtual planning together with intraoperative imaging has the advantage that the position
Intraoperative imaging
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