Radiological Findings and Benefits of Intraoperative CBCT in Maxillofacial Surgery

The radiological findings are summarized in Fig. 4, showing the significant benefits of integrating intraoperative CBCT into maxillofacial surgery workflows.

Fig 4: Radiological findings after checking the intraoperative CBCT images.

This approach allowed for real-time comparison of surgical outcomes with the preoperative virtual surgical plan, offering surgeons immediate feedback to make precise adjustments during the procedure. By enhancing intraoperative accuracy, this workflow helped achieve a higher degree of precision in meeting planned surgical objectives.

The procedures using this method included a range of complex interventions, such as:

• Temporomandibular joint (TMJ) positioning with patient-specific prosthesis (Fig. 5)

Fig 5: Preoperative virtual planning (a, b, c) in a case of a bilateral TMJ prosthesis placement. Intraoperative CBCT result (d). Superposition of the virtual planning with the intraoperative result to corroborate the position of the TMJ prosthesis (e, f).

• Orthognathic surgery (Fig. 6)

Fig 6: Orthognatic surgery case where the left condyle was out of glenoid fossa (a, b, c). Mandibular osteosynthesis was redone and then the intraoperative CBCT repeated to corroborate its position (d, e).

• Orbital reconstruction with patient-specific implants (Fig. 7): intraoperative CBCT ensured the precise placement of patient-specific implants.

Fig 7: Intraoperative CBCT in an oncological reconstruction surgery of a patient with radio-induced maxillary osteosarcoma. Surgical virtual planning (a), surgical cutting guides (b) and a ZMC prosthesis (c) were patient-specific. An ICBCT was performed after resection to ensure proper surgical margins (d). Moreover, surgical piece was checked with 3D-printed model with the resection (e). A second ICBCT was performed after ZMC prosthesis placement to check accuracy (f).

By detecting and addressing deviations from the surgical plan during the procedure, intraoperative CBCT significantly reduced the potential need for secondary surgeries. This immediate correction capability was particularly beneficial in cases of chin misalignment (n=8) and condylar malposition (n=4), where CBCT imaging enabled realignment of the condyle before completing the surgery (Fig. 6). The ability to make these adjustments in real time ensured optimal positioning and prevented postoperative complications related to misalignment.