title: Use of intraoperative computed tomography in complex facial fracture reduction and fixation.
abstract: BACKGROUND
  Using conventional complex facial fracture management principles, confirmation of adequate facial fracture reduction can be achieved only by obtaining a postoperative computed tomography (CT) scan. If the CT scan revealed any discrepancy in fracture alignment, additional procedures for correction may be required. The concept of intraoperative CT scanning provides immediate postreduction or intraoperative information that orients the surgeon to the potential need for additional maneuvers for improved fracture reduction and osseous fixation. We assessed the early technical feasibility of real-time intraoperative CT scanning using the xCAT ENT (Xoran Technologies, Inc, Ann Arbor, MI), for monitoring of fracture reduction with the possibility of immediate intraoperative revision if needed, potentially obviating the need for revision procedures.
  
  
  METHODS
  Three adult patients were studied who were admitted from the emergency department. During their respective reconstructive procedures, the xCAT ENT was used to provide images: Axial, coronal, sagittal, and three-dimensional reformatted images with segmentation of the CT data set and mirroring of the reconstructed side to the unaffected side were used for precise measurement and comparison of the reconstruction. The scans were examined by the operating surgeon and an intraoperative decision was made as to whether immediate revision was required.
  
  
  RESULTS
  Facial fracture management with intraoperative CT monitoring was changed in 2 of the 3 cases. One patient who underwent immediate revision had an open reduction-internal fixation after cranialization. The second patient who had a revision had a persistent subcondylar fracture that was found not amenable to closed reduction.
  
  
  CONCLUSIONS
  The intraoperative CT scan may positively change the outcome of facial fracture reduction especially when dealing with complex fractures. Additional studies are needed for studying its potential impact in monitoring reduction of facial fractures.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Rabie
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Ibrahim
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D001860:Bone Plates; D005147:Facial Bones / Q000293:injuries* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery; D005624:Frontal Bone / Q000293:injuries; D005626:Frontal Sinus / Q000293:injuries / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007430:Intraoperative Care; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery; D008440:Maxillary Fractures / Q000601:surgery; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries; D010347:Patient Care Planning; D015641:Radiography, Interventional / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012887:Skull Fractures / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome