The Impact of Using Intraoperative Computed Tomography on the Number of Surgical Approaches Used for Zygomaticomaxillary Complex Repair.

Background: Zygomaticomaxillary complex (ZMC) fractures are repaired using a variety of surgical approaches. Utilization of intraoperative computed tomography (CT) may reduce the number of surgical approaches. Study Objective: To compare the use of intraoperative CT for the operative repair of ZMC fractures, as measured by the number of surgical approaches. Method: A retrospective review was completed on patients who underwent surgical repair of ZMC fractures by facial plastic and reconstructive surgeons at a tertiary hospital. Results: Eighty-four patients underwent open ZMC repair between 2009 and 2022. Patients had a median age of 42 years (range: 19-93, interquartile range 29-59), were 76.2% Male (n = 64) and 78.6% (N = 66) White. There were 38 and 46 patients in the pre- and post-intraoperative CT cohorts, respectively. The most common incision utilized was a gingivobuccal incision (98.8%), followed by a transconjunctival approach (47.6%). Cases in which CT was utilized had a significantly reduced number of incisions (mean incisions: 2.45 pre vs. 1.67 post, p < 0.001), with large reductions in the rate of transconjunctival incisions (pre-intraoperative CT: 73.7%; post-intraoperative CT: 26.1%, p < 0.001) and lateral canthotomy incisions (23.7% vs. 4.3%, p < 0.001). Conclusion: Intraoperative CT reduces the number of surgical approaches in patients with ZMC trauma.