Oral and maxillofacial radiology
Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and maxillofacial surgery

https://doi.org/10.1016/j.tripleo.2006.05.008Get rights and content

Objectives

Intraoperative cone-beam computerized tomography (CBCT) imaging has been introduced in oral and maxillofacial surgery. Using midfacial fractures as the pioneer model, this study describes the spectrum of further promising clinical indications for intraoperative CBCT and a clinical combination with intraoperative navigation.

Study design

One hundred seventy-nine patients admitted for surgical treatment of the facial skeleton were included in the study. Intraoperatively, 3-dimensional images were generated with the mobile CBCT scanner Arcadis Orbic 3D, obtained from Siemens Medical Solutions, in a variety of indications.

Results

The acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the postoperative result in all cases. In the example of a facial gunshot injury, a navigation system for intraoperative localization of the metal foreign bodies was used.

Section snippets

Technical material

The 3D images were generated with the mobile CBCT scanner Arcadis Orbic 3D, obtained from Siemens Medical Solutions (Erlangen, Germany). The base system consists of a mobile isocentric C-arm with an integrated x-ray source and an opposite 9-inch x-ray image intensifier and television (TV) system. Technical specifications of the single tank (x-ray generator/tube) are shown in Table I. The image intensifier is based upon the metal-enamel technology with Mu-metal shielding and disposes of a grid

Practical applicability

The intraoperative handling of the mobile CBCT scanner was uncomplicated in all cases. Although the size of the scanned volume was critical in large regions of interests (e.g., bilateral condylar fractures), after proper individual positioning of the isocenter with the help of laser devices and single fluoroscopic images, 1 dataset was sufficient to visualize the region of interest in all patients. Performing the isocentric orbital rotation and generating the secondary reconstructions took

Discussion

After successful implementation of the cone-beam technology in oral and maxillofacial radiology, the transfer in the operation theater by combining this technique with the traditional C-arm design has been the next milestone in 3D imaging. Thus, the intraoperative acquisition of Digital Imaging and Communications in Medicine (DICOM)–standard data sets associated with a low level of radiation exposure has been realized.10 The transfer of the postoperative radiologic examination into the

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  • Cited by (0)

    The first two authors contributed equally to this work.

    1

    Dr. Heiland has received grant support from Siemens Medical Solutions.

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