Results of a new study show the extent to which intraoperative computed tomography (CT) can provide real-time feedback to surgeons during maxillofacial and reconstructive surgery for intraoperative decision making.
The goal of the study, headed by David A. Shaye, M.D., of the Massachusetts Eye and Ear Infirmary in Boston, was threefold: evaluate the amount of time needed to perform intraoperative CT scans during surgery; determine any trend toward shorter total scan times as experience is gained with the technique; and identify the characteristics of cases that required intraoperative revision based on the scan’s results. Travis T. Tollefson, M.D., and E. Bradley Strong, M.D., both of the department of otolaryngology at the University of California, Davis, are co-authors with Dr. Shaye.
The researchers conducted a retrospective review of all maxillofacial reconstruction procedures they did that used intraoperative CT between January 1, 2012, and March 31, 2014. They measured time needed for intraoperative CT scans and identified and analyzed trends. Covariates included age, sex, complexity of fractures, type of procedure, total scan time, surgeon and need for intraoperative revision based on intraoperative CT findings.
Overall, the authors identified 38 cases, 30 of which were males. They defined 18 cases as routine, 20 as complex. Isolated orbital fractures were the most common fracture in both the routine and complex cases. The authors found that the mean total scan time was 14.5 minutes and did not differ based on complexity. Intraoperative revisions were performed on 9 patients and were more common in complex cases. The mean scan time for the most experienced surgeon was 3.78 minutes, which was 1.53 minutes shorter than for the other surgeons as a group.
“Current intraoperative CT scanning techniques are rapid, averaging 14.5 minutes per case,” the authors conclude. “No decrease in total scan time was noted during the study; however, the surgeon most experienced with the CT software had the shortest total scan times. Intraoperative revisions were most common in complex cases. We recommend surgeons consider the use of intraoperative CT imaging for maxillofacial reconstruction, particularly in complex procedures.”
The study appears in JAMA Facial Plastic Surgery.