The Impact of Using Intraoperative Computed Tomography on the Number of Surgical Approaches Used for Zygomaticomaxillary Complex Repair

<b>Background:</b> Zygomaticomaxillary complex (ZMC) fractures are repaired using a variety of surgical approaches. Utilization of intraoperative computed tomography (CT) may reduce the number of surgical approaches. <b>Study Objective:</b> To compare the use of intraoperative CT for the operative repair of ZMC fractures, as measured by the number of surgical approaches. <b>Method:</b> A retrospective review was completed on patients who underwent surgical repair of ZMC fractures by facial plastic and reconstructive surgeons at a tertiary hospital. <b>Results:</b> Eighty-four patients underwent open ZMC repair between 2009 and 2022. Patients had a median age of 42 years (range: 19-93, interquartile range 29-59), were 76.2% Male (<i>n</i> = 64) and 78.6% (<i>N</i> = 66) White. There were 38 and 46 patients in the pre- and post-intraoperative CT cohorts, respectively. The most common incision utilized was a gingivobuccal incision (98.8%), followed by a transconjunctival approach (47.6%). Cases in which CT was utilized had a significantly reduced number of incisions (mean incisions: 2.45 pre vs. 1.67 post, <i>p</i> < 0.001), with large reductions in the rate of transconjunctival incisions (pre-intraoperative CT: 73.7%; post-intraoperative CT: 26.1%, <i>p</i> < 0.001) and lateral canthotomy incisions (23.7% vs. 4.3%, <i>p</i> < 0.001). <b>Conclusion:</b> Intraoperative CT reduces the number of surgical approaches in patients with ZMC trauma.