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Quantitative Determination of Zygomaticomaxillary Complex Position Based on Computed Tomographic Imaging

Mao, Shih-Hsuan MD; Hsieh, Yu-Hsuan MD; Chou, Pang-Yun MD; Shyu, Victor Bong-Hang MD; Chen, Chien-Tzung MD; Chen, Chih-Hao MD, PhD

doi: 10.1097/SAP.0000000000000703
Research Papers
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Background The zygomaticomaxillary complex (ZMC) is frequently involved in craniofacial fractures. We propose an objective approach for defining the ZMC position on skeletal and soft tissue by using Amira to process 3-dimensional (3D) facial computed tomography (CT) images.

Aim and Objectives In this study, we aim to propose 1 anthropometric system, facilitated based on CT images, which can be used in quantitative analysis of ZMC position and examine the symmetry of skeletal and soft tissue of the ZMC with high reliability and validity.

Methods Twenty Taiwanese trauma patients with pure mandibular fracture but bilateral intact ZMCs were recruited to participate in this study. The head position was adjusted in 3D planes during the examinations. The distances between the zygion and nasion and maxillozygion and nasion were defined as the x plane. The y plane was defined as the distance between the maxillozygion to the vertex and orbitale to the vertex. The distance between the maxillozygion and opisthocranion was defined as the z plane.

Results The results indicated that the intrasubject variability was 0.7 to 1.6 and 0.1 to 1.8 mm in skeletal and soft tissue, respectively. The intersubject variability ranged from 3.1 to 9.2 and 1.8 to 9.3 mm in skeletal and soft tissue, respectively. The proposed anthropometric system demonstrated high validity and reliability in ZMC measurements. No significant difference was observed among bilateral ZMCs, indicating the feasibility of the mirroring technique during surgical processes.

Conclusions We conclude that the anthropometric system for processing 3D facial CT images facilitated by Amira has potential implication in the assessment and reconstruction of the ZMC in both skeletal and soft tissue.

From *Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, College of Medicine, Taoyuan; and †Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan, Republic of China.

Received October 13, 2015, and accepted for publication, after revision November 6, 2015.

S.-H.M. and Y.-H.H. contributed equally to this work.

Conflicts of interest and sources of funding: none declared.

Reprints: Chih-Hao Chen, MD, PhD, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, College of Medicine, 5, Fu-Hsin St, Kwei-Shan, Taoyuan 333, Taiwan, ROC. E-mail: chihhaochen5027@yahoo.com.tw.

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