J Oral Maxillofac Surg 67:515-521, 2009 Intraoperative Cone-Beam Computed Tomography in Oral and Maxillofacial Surgery Using a C-Arm Prototype: First Clinical Experiences After Treatment of Zygomaticomaxillary Complex Fractures Philipp Pohlenz, MD, DMD,* Felix Blake, MD, DMD,† Marco Blessmann, MD, DMD,‡ Ralf Smeets, MD, DMD,§ Christian Habermann, MD,¶ Philipp Begemann, MD, Rainer Schmelzle, MD, DMD, PhD,# and Max Heiland, MD, DMD, PhD** Purpose: To describe the first clinical applications of intraoperative cone-beam computed tomography with an integrated flat-panel detector in oral and maxillofacial surgery after surgical treatment of zygomaticomaxillary complex fractures Patients and Methods: Nine cone-beam computed tomography datasets of patients with zygomatico- maxillary complex fractures were intraoperatively acquired using a mobile isocentric C-arm (PowerMo- bil; Siemens Medical Solutions, Erlangen, Germany), including a flat-panel detector. Datasets based on 400, 200, and 100 fluoroscopic images were performed with different tube currents (4.6 mA, 3.3 mA, 2.3 mA, 1.2 mA, and 0.5 mA) and a current tube voltage of 100 kV. Postprocessing resulted in 15 different datasets available for comparison with corresponding preoperative computed tomography datasets. Four oral and maxillofacial surgeons and 2 experienced radiologists evaluated each dataset regarding noise, transition, and the delimitation of landmarks. Results: All examinations were successfully performed. Reconstructed datasets showed high-resolution images of all midfacial osseous structures in near-computed tomography quality. Regarding high-contrast structures, detailed analyses of datasets acquired in this study suggest that the parameters 400 projections, 1.2 mA, and 100 kV are sufficient. In terms of soft-tissue visualization, a higher level of mA seems preferable. Conclusions: The tested prototype predicts a new era in cone-beam computed tomography imaging. The integration of a flat-panel detector will overcome the limitations of current available systems. The size of the field of view is increased allowing regularly the visualization of the whole facial skeleton. Particularly in cases of open reduction of unilateral fractures, the assessment of symmetry is of clinical value. © 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:515-521, 2009 *Senior Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. †Senior Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ‡Senior Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. §Department of Oral and Maxillofacial Surgery, University Hos- pital Aachen, Aachen, Germany. ¶Department of Diagnostic and Interventional Radiology, Univer- sity Medical Center Hamburg-Eppendorf, Hamburg, Germany. Department of Diagnostic and Interventional Radiology, Univer- sity Medical Center Hamburg-Eppendorf, Hamburg, Germany. #Associate Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. **Professor and Head, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. M.H. received grant support from Siemens Medical Solutions (Erlangen, Germany). Address correspondence and reprint requests to Dr Pohlenz: Department of Oral and Maxillofacial Surgery, Nordwestdeutsche Kieferklinik, University Medical Center Hamburg-Eppendorf, Mar- tinistrasse 52, D-20246 Hamburg, Germany; e-mail: ppohlenz@ uke.uni-hamburg.de © 2009 American Association of Oral and Maxillofacial Surgeons 0278-2391/09/6703-0008$36.00/0 doi:10.1016/j.joms.2008.06.086 515