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Introduction <p>Fractures of the naso-orbito-ethmoid (NOE) complex require precise three-dimensional bony reconstruction for optimal functional and aesthetic outcomes. Intraoperative cone-beam computed tomography (CBCT) enables real-time visualization of fracture reduction and subsequent correction, potentially reducing functional and aesthetic sequelae. We aimed to assess the impact of intraoperative CBCT on outcomes in surgically treated NOE fractures.</p> Materials and Methods <p>This retrospective case series included 43 subjects (34 men and 9 women) aged 16 years or older who had undergone surgical treatment for NOE complex fractures between February 2015 and November 2020 at the Department of Maxillofacial Surgery of a Swiss university hospital with intraoperative CBCT or postoperative CT scans. Postoperative patient dissatisfaction with aesthetic or functional outcomes, the need for secondary surgical revision, and radiographic signs of imperfect fracture reduction were assessed. The analyses encompassed descriptive statistics, Fisher tests, and Spearman correlation analyses, with statistical significance set at <i>p</i> &lt; .05.</p> Results <p>Intraoperative CBCT was performed in 38 subjects, with 10 (23.3%) requiring intraoperative revision. 24 subjects (55.8%) reported postoperative symptoms, mostly related to aesthetic concerns. 8 subjects (18.6%) underwent secondary surgery, primarily for patient-specific orbital reconstruction. Correlation analyses indicated a statistically significant association between higher Markowitz type and postoperative symptoms (<i>R</i> = .3609, <i>p</i> = .017) and their number (r<sub>s</sub>=0.3377, <i>p</i> = .027). No significant association was found between postoperative symptoms and intraoperative revision (<i>p</i> = .72).</p> Conclusion <p>Intraoperative CBCT verification of fracture reduction may reduce secondary revision rates and improve patient satisfaction, ensuring more predictable surgical outcomes in NOE fracture management.</p>

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The Effect of Intraoperative Three-Dimensional Imaging in Optimizing Management of Naso-orbito-ethmoid Fractures: Findings from a Retrospective Case Series

  • 期刊论文

  • 发表日期：

    2026年3月18日

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  • Joël Bettschen,
  • Daniel Wiedemeier,
  • Maximilian Eberhard Hermann Wagner,
  • Harald Essig,
  • Daphne Schönegg,
  • Michael Blumer

摘要

Introduction

Fractures of the naso-orbito-ethmoid (NOE) complex require precise three-dimensional bony reconstruction for optimal functional and aesthetic outcomes. Intraoperative cone-beam computed tomography (CBCT) enables real-time visualization of fracture reduction and subsequent correction, potentially reducing functional and aesthetic sequelae. We aimed to assess the impact of intraoperative CBCT on outcomes in surgically treated NOE fractures.

Materials and Methods

This retrospective case series included 43 subjects (34 men and 9 women) aged 16 years or older who had undergone surgical treatment for NOE complex fractures between February 2015 and November 2020 at the Department of Maxillofacial Surgery of a Swiss university hospital with intraoperative CBCT or postoperative CT scans. Postoperative patient dissatisfaction with aesthetic or functional outcomes, the need for secondary surgical revision, and radiographic signs of imperfect fracture reduction were assessed. The analyses encompassed descriptive statistics, Fisher tests, and Spearman correlation analyses, with statistical significance set at p < .05.

Results

Intraoperative CBCT was performed in 38 subjects, with 10 (23.3%) requiring intraoperative revision. 24 subjects (55.8%) reported postoperative symptoms, mostly related to aesthetic concerns. 8 subjects (18.6%) underwent secondary surgery, primarily for patient-specific orbital reconstruction. Correlation analyses indicated a statistically significant association between higher Markowitz type and postoperative symptoms (R = .3609, p = .017) and their number (rs=0.3377, p = .027). No significant association was found between postoperative symptoms and intraoperative revision (p = .72).

Conclusion

Intraoperative CBCT verification of fracture reduction may reduce secondary revision rates and improve patient satisfaction, ensuring more predictable surgical outcomes in NOE fracture management.