Specific aims & objectives: Complex facial fractures are predominantly managed surgically, followed by postoperative imaging to check the position of inserted prostheses and fracture reduction. This review of management algorithms aims to highlight the benefits of intraoperative cone beam computed tomography (CBCT) [DynaCT, Siemens Artis ZeegoTM], in order to achieve the best results during surgery, with the goal of changing the standard of care provided to such patients.
Methods: A general overview of traditional management algorithms of complex facial fractures is discussed, and is compared with a detailed description of the current environment in the ‘Hybrid Operating Theatre’ at Royal Prince Alfred Hospital, Sydney NSW, Australia. A short series of patients is also discussed with examples of preoperative and intraoperative images.
Results: The Hybrid Operating Theatre was used to perform zygomatic complex and orbital floor reconstructions in a short series of patients. As CBCT was a relatively new resource shared amongst different surgical specialties, this service was offered to patients with facial fractures whenever possible. Patients who had intraoperative imaging had shorter length of stays in hospital and avoided formal departmental postoperative imaging (eg. CT, X-rays). The position of fracture reduction and prosthetic placement was checked immediately and corrected if necessary during the surgical procedure.
Discussion: Whilst intraoperative imaging is the gold standard in other operations requiring bony fixation (eg. hand trauma, orthopaedic procedures) or to confirm important anatomy (eg. intraoperative cholangiogram), it still remains absent from the management algorithm of complex facial fractures. There are obvious benefits of immediately confirming fracture reduction and ideal prosthetic placement, and it may also reduce morbidity by avoiding additional anaesthetic encounters during corrective procedures.
Conclusion: CBCT is an available and emerging technology in theatre environments, and its use should be considered as the new standard of care in managing complex facial fractures.