Intraoperative ultrasound control of zygomatic arch fractures: Does additional imaging improves reduction quality?

Publication date: Available online 27 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Johannes Buller, Matthias Zirk, Matthias Kreppel, Volker Maus, Joachim E. Zöller

Abstract

Purpose

Intraoperative navigation to assess anatomic reduction is the general trend in maxillofacial trauma surgery. Aim of this study was to evaluate closed reduction outcome of isolated zygomatic arch fractures using ultrasound compared to palpation control.

Methods

In this case-control study, we identified consecutive treated patients who underwent closed reduction of isolated zygomatic arch fractures via Volkmann's reposition hook with intraoperative ultrasound. Controls were patients with the equal diagnosis and surgical procedure without ultrasound imaging. Pre- and postoperative radiographic data sets were geometrically analyzed. We compared the outcome variables in both study groups that were postoperative cortical step, persistent postoperative displacement and overall grade of reduction. Subgroups of fracture patterns were classified as M-shaped or variable fractures. Statistical analysis was performed using t test for continuous variables and two-sided chi-square test for categorical variables with p-value <0.05 defined as significant.

Results

A total of 16 cases with intraoperative ultrasound and 60 controls were identified from the institution's database. The angle of postoperative displacement was significantly reduced in the ultrasound group regarding all fractures (2.4° vs. 5.3°; p=0.004) and the variable fracture type (1.6° vs. 8.1°; p=0.005). Overall grade of reduction was improved in the ultrasound group for all fractures (p=0.03) but with no difference solely for M-shaped fractures (p=0.37).

Conclusion

Although reduction control via palpation and probing using the Volkmann's hook showed satisfactory results for M-shaped fractures, the additional intraoperative ultrasound imaging promises increasing success rates for variable configured zygomatic arch fractures.

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