Impact of intraoperative CT on implant accuracy and reoperation rates in orbital floor reconstruction

BACKGROUND: Implant malposition is a leading cause of reoperation after orbital floor reconstruction. Intraoperative computed tomography (CT) enables immediate assessment and correction, however its impact on implant positioning accuracy and outcomes remains insufficiently studied. MATERIALS AND METHODS: This retrospective study included 86 patients with isolated orbital floor fractures treated with radiopaque implants between 2011 and 2023 at Uppsala University Hospital. Sixty-five patients underwent postoperative CT and 21 intraoperative CT. Eight senior surgeons from all Swedish university hospitals independently reviewed anonymized scans under hypothetical intraoperative and postoperative conditions, indicating whether they would adjust the implant intraoperatively or recommend reoperation postoperatively. In the intraoperative group, implant position was assessed on final CT obtained after any CT-guided adjustment. Actual re-intervention rates were recorded. RESULTS: Recommendations for implant adjustment were significantly more frequent in the postoperative CT group than in the intraoperative CT group (45% vs. 19%, p = 0.042). Unanimous agreement that no adjustment was required occurred more often in the intraoperative CT group (48% vs. 22%). Consensus among ≥3 experts favoring reoperation was observed in 20% of postoperative cases and in none of the intraoperative cases. The perceived need for reoperation was lower in the intraoperative than in the postoperative CT group (5% vs. 15%, p = 0.45), as were actual reoperation rates (5% vs. 11%, p = 0.68). CONCLUSIONS: Intraoperative CT was associated with improved expert-assessed implant positioning. Although reoperation rates were lower in the intraoperative CT group, these differences did not reach statistical significance.