Intraoperative Imaging Changes Management in Orbital Fracture Repair

Abstract Purpose Intraoperative imaging is gaining widespread use in the management of facial fracture repair. The aim of this study is to determine if intraoperative imaging changes the management of orbital fracture repair. Methods A retrospective case series was performed for all cases of orbital fracture repair from 2008 to 2015 in which the intraoperative O-arm was used at Regions Hospital, a level I trauma center. The primary outcome variable was if a change in management occurred, ranging from orbital plate repositioning to proceeding with orbital floor exploration. Results The study sample was composed of 101 patients with a mean age of 40 +/- 15 years. Approximately 75% (76/101) of patients were male, and 25% (25/101) female. All cases were secondary to assault, motor vehicle accident, fall, or gunshot wounds. The use of the O-arm resulted in a change in management in 44% (44/101) of cases. In 48% (21/44) of these cases in which intraoperative imaging resulted in a change in management, the orbital plate was repositioned to optimize repair. In 16% (7/44) of these cases, the orbital plate was exchanged for a different size and/or type of plate. In 7% (3/44) of these cases, the orbital plate was reshaped by bending to improve contour for the repair. In another 7% (3/44) of these cases, the orbital plate was reshaped by trimming the plate to optimize the length and/or width of the plate for repair. In 7% of these cases, the orbital floor required exploration based on intraoperative imaging. In 5% of these cases, the orbital floor was found to be adequately reduced after zygoma reduction based on intraoperative imaging, and did not require exploration. Conclusions The use of intraoperative imaging allows the surgeon to make real-time changes in operative management ranging from orbital plate repositioning to deciding whether to proceed with orbital floor exploration. This not only allows for immediate optimization of repair, but may also decrease the need for revision procedures, reducing patient morbidity and improving patient outcomes.