The impact of intraoperative CT on maxillofacial fracture surgery: A systematic review of the past 10 years.

BACKGROUND

Maxillofacial fracture surgeries are technically challenging due to complex anatomy and limited intraoperative visibility, often leading to suboptimal reduction and secondary procedures. Intraoperative CT has been increasingly used in Maxillofacial fracture surgeries to provide real-time imaging feedback and improve surgical accuracy.

PURPOSE: This review aims to clarify the clinical value of intraoperative CT in maxillofacial fracture surgeries by systematically evaluating its impact on surgical outcomes, revision rates, and associated risks.

STUDY SELECTION: Clinical studies published in English from 2015 onward were included if they investigated the use of intraoperative CT in maxillofacial fracture surgeries and reported relevant data on revision rates, surgical outcomes, operative time, or radiation exposure. Studies were excluded if they were non-English, non-full-text, published before 2015, or lacked sufficient outcome data. Study selection was performed independently by two reviewers through title/abstract screening and full-text assessment. Of 440 initially identified records, 22 studies (5.0%) met the inclusion criteria.

RESULTS

A total of 22 studies involving over 1100 patients were included. The overall intraoperative revision rate was 25.3% (242/955). A meta-analysis of 21 studies estimated a pooled revision rate of 24.2% (95% CI: 19.9%-28.5%) using a random-effects model. Four studies reported additional intraoperative CT time ranging from 10 to 28 min. Eight studies reported patient radiation doses from 10 μSv to 2.1 mSv per scan. Comparative studies demonstrated improved surgical accuracy and reduced complication rates in intraoperative CT groups, with some differences reaching statistical significance CONCLUSIONS AND RELEVANCE: Intraoperative CT appears to enhance surgical precision and facilitate real-time revision in maxillofacial fracture surgeries, potentially reducing complications and improving postoperative outcomes. Despite added operative time, radiation exposure, and cost, its clinical benefits may outweigh these drawbacks in appropriately selected cases. These findings support the selective use of intraoperative CT in Maxillofacial fracture management.

REGISTRATION / FUNDING: This review is registered with PROSPERO (CRD420251028655). No funding was received.