Computer-Assisted Evaluation of Zygomatic Fracture Outcomes: Case Series and Proposal of a Reproducible Workflow.

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Tomography Pub Date : 2025-02-18 DOI:10.3390/tomography11020019

Simone Benedetti, Andrea Frosolini, Flavia Cascino, Laura Viola Pignataro, Leonardo Franz, Gino Marioni, Guido Gabriele, Paolo Gennaro

{"title":"Computer-Assisted Evaluation of Zygomatic Fracture Outcomes: Case Series and Proposal of a Reproducible Workflow.","authors":"Simone Benedetti, Andrea Frosolini, Flavia Cascino, Laura Viola Pignataro, Leonardo Franz, Gino Marioni, Guido Gabriele, Paolo Gennaro","doi":"10.3390/tomography11020019","DOIUrl":null,"url":null,"abstract":"Background: Zygomatico-maxillary complex (ZMC) fractures are prevalent facial injuries with significant functional and aesthetic implications. Computer-assisted surgery (CAS) offers precise surgical planning and outcome evaluation. The study aimed to evaluate the application of CAS in the analysis of ZMC fracture outcomes and to propose a reproducible workflow for surgical outcome assessment using cephalometric landmarks.Methods: A retrospective cohort study was conducted on 16 patients treated for unilateral ZMC fractures at the Maxillofacial Surgery Unit of Siena University Hospital (2017-2024). Inclusion criteria included ZMC fractures classified as Zingg B or C, treated via open reduction and internal fixation (ORIF). Pre- and post-operative CT scans were processed for two- and three-dimensional analyses. Discrepancies between CAS-optimized reduction and achieved surgical outcomes were quantified using cephalometric landmarks and volumetric assessments.Results: Out of the 16 patients (69% male, mean age 48.1 years), fractures were predominantly on the right side (81%). CAS comparison between the post-operative and the contralateral side revealed significant asymmetries along the X and Y axes, particularly in the fronto-zygomatic suture (FZS), zygo-maxillary point (MP), and zygo-temporal point (ZT). Computer-assisted comparison between the post-operative and the CAS-simulated reductions showed statistical differences along all three orthonormal axes, highlighting the challenges in achieving ideal symmetry despite advanced surgical techniques. CAS-optimized reductions demonstrated measurable improvements compared to traditional methods, underscoring their utility in outcome evaluation.Conclusions: CAS technology enhances the precision of ZMC fracture outcome evaluation, allowing for detailed comparison between surgical outcomes and virtual simulations. Its application underscores the potential for improved surgical planning and execution, especially in complex cases. Future studies should focus on expanding sample size, refining workflows, and integrating artificial intelligence to automate processes for broader clinical applicability.","PeriodicalId":51330,"journal":{"name":"Tomography","volume":"11 2","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11860590/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Tomography","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/tomography11020019","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Zygomatico-maxillary complex (ZMC) fractures are prevalent facial injuries with significant functional and aesthetic implications. Computer-assisted surgery (CAS) offers precise surgical planning and outcome evaluation. The study aimed to evaluate the application of CAS in the analysis of ZMC fracture outcomes and to propose a reproducible workflow for surgical outcome assessment using cephalometric landmarks.

Methods: A retrospective cohort study was conducted on 16 patients treated for unilateral ZMC fractures at the Maxillofacial Surgery Unit of Siena University Hospital (2017-2024). Inclusion criteria included ZMC fractures classified as Zingg B or C, treated via open reduction and internal fixation (ORIF). Pre- and post-operative CT scans were processed for two- and three-dimensional analyses. Discrepancies between CAS-optimized reduction and achieved surgical outcomes were quantified using cephalometric landmarks and volumetric assessments.

Results: Out of the 16 patients (69% male, mean age 48.1 years), fractures were predominantly on the right side (81%). CAS comparison between the post-operative and the contralateral side revealed significant asymmetries along the X and Y axes, particularly in the fronto-zygomatic suture (FZS), zygo-maxillary point (MP), and zygo-temporal point (ZT). Computer-assisted comparison between the post-operative and the CAS-simulated reductions showed statistical differences along all three orthonormal axes, highlighting the challenges in achieving ideal symmetry despite advanced surgical techniques. CAS-optimized reductions demonstrated measurable improvements compared to traditional methods, underscoring their utility in outcome evaluation.

Conclusions: CAS technology enhances the precision of ZMC fracture outcome evaluation, allowing for detailed comparison between surgical outcomes and virtual simulations. Its application underscores the potential for improved surgical planning and execution, especially in complex cases. Future studies should focus on expanding sample size, refining workflows, and integrating artificial intelligence to automate processes for broader clinical applicability.

查看原文本刊更多论文

背景：颧颌面复合体（ZMC）骨折是一种常见的面部损伤，对功能和美观有重大影响。计算机辅助手术（CAS）可提供精确的手术规划和结果评估。本研究旨在评估计算机辅助手术在 ZMC 骨折疗效分析中的应用，并提出一套可重复的工作流程，利用头颅测量地标进行手术疗效评估：对锡耶纳大学医院颌面外科治疗的16例单侧ZMC骨折患者（2017-2024年）进行了回顾性队列研究。纳入标准包括ZMC骨折分类为Zingg B或C，通过开放复位和内固定（ORIF）治疗。对术前和术后的 CT 扫描进行二维和三维分析。使用头颅测量地标和体积评估对CAS优化的骨折复位和手术效果之间的差异进行量化：在 16 名患者中（69% 为男性，平均年龄 48.1 岁），骨折主要发生在右侧（81%）。CAS 对术后一侧和对侧进行比较后发现，沿 X 轴和 Y 轴存在明显的不对称，尤其是在前颧缝（FZS）、颧颌点（MP）和颧颞点（ZT）。计算机辅助比较术后与 CAS 模拟的缩窄结果显示，在所有三个正交轴上都存在统计学差异，这凸显了尽管采用了先进的手术技术，但要达到理想的对称性仍存在挑战。与传统方法相比，CAS优化的缩窄效果有了明显改善，突出了其在结果评估中的实用性：CAS技术提高了ZMC骨折结果评估的精确度，可对手术结果和虚拟模拟结果进行详细比较。它的应用强调了改进手术规划和执行的潜力，尤其是在复杂病例中。未来的研究应侧重于扩大样本量、完善工作流程以及整合人工智能以实现流程自动化，从而实现更广泛的临床应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Tomography Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

2.70

自引率

10.50%

发文量

222

期刊介绍： TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.