# Intraoperative ultrasonographic evaluation of inferior orbital rim reduction in non-comminuted zygomatic fractures: A case series of six patients

## TL;DR

This study shows that ultrasound can accurately assess zygomatic fracture reduction during surgery without radiation, potentially improving outcomes.

## Contribution

This is among the first case series to document ultrasound-guided evaluation of orbital rim reduction during J-hook intervention.

## Key findings

- Ultrasound demonstrated comparable efficacy to CBCT for assessing fracture reduction.
- Real-time imaging supports intraoperative decision-making, potentially reducing the need for secondary revision procedures.

## Abstract

Zygomatic fractures are common in maxillofacial trauma and often require surgical intervention for the restoration of facial symmetry. The inferior orbital rim significantly influences cheekbone asymmetry. The management of zygomatic fractures involves estimating the adequacy of reduction by comparing the malar projection on the fracture and healthy sides. This clinical approach is subjective and lacks precision.

Six consecutive patients with non-comminuted zygomatic fractures were included in the study. Ultrasound was performed pre- and post-reduction during the surgery to visualize the fracture site and measure the displacement by visualizing the periosteal discontinuity. The results were compared with those of pre- and post-operative CBCT scans.

Ultrasound demonstrated comparable efficacy to CBCT for assessing fracture reduction. Unlike CBCT, ultrasound involves no radiation exposure and allows for real-time intra-operative assessment, potentially reducing the need for revision surgery.

Ultrasound is a precise and practical modality for evaluating zygomatic fracture reduction during J-hook procedures. It offers a radiation-free, inexpensive and readily available modality that improves intra-operative decision-making.

•Intraoperative ultrasonography enables precise, radiation-free assessment of zygomatic fracture reduction, specifically at the inferior orbital rim.•Compared to CBCT, ultrasound delivers equivalent accuracy in detecting bone displacement and verifying periosteal continuity during surgery.•Real-time imaging supports intraoperative decision-making, potentially reducing the need for secondary revision procedures.•This is among the first case series to document ultrasound-guided evaluation of orbital rim reduction during J-hook intervention.•The study highlights ultrasonography as a practical and reproducible tool in maxillofacial trauma surgery.

Intraoperative ultrasonography enables precise, radiation-free assessment of zygomatic fracture reduction, specifically at the inferior orbital rim.

Compared to CBCT, ultrasound delivers equivalent accuracy in detecting bone displacement and verifying periosteal continuity during surgery.

Real-time imaging supports intraoperative decision-making, potentially reducing the need for secondary revision procedures.

This is among the first case series to document ultrasound-guided evaluation of orbital rim reduction during J-hook intervention.

The study highlights ultrasonography as a practical and reproducible tool in maxillofacial trauma surgery.