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Chodankar NU, Dhupar V, Akkara F, Vijay V. Matrixmidface Preformed Orbital Implants for Three-Dimensional Reconstruction of Orbital Floor and Medial Wall Fractures: A Prospective Clinical Study. Craniomaxillofac Trauma Reconstr 2024; 17:104-114. [PMID: 38779396 PMCID: PMC11107816 DOI: 10.1177/19433875231171749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Study Design Prospective Interventional study. Objective To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures. Methods This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of orbital floor and medial wall fracture defects using Matrixmidface Preformed Orbital plates and open reduction and internal fixation of associated fractures. The following parameters were studied preoperative and postoperative enophthalmos, hypoglobus, orbital volume; correction of diplopia, intraoperative and postoperative complications. Results All 14 patients were males aged between 19 and 42 years. The most common mode of injury was found to be road traffic accidents (RTAs) followed by self-fall and trauma at workplace. Orbital fractures were associated with other concomitant maxillofacial fractures in 12 patients (85.7%) while 2 patients (14.3%) had pure blowout fractures. Significant improvement of enophthalmos was noted from preoperative period to 1 week, 6 weeks, and 6 months postoperatively (P value .02, .01, and .01, respectively). Out of 11 patients with preoperative hypoglobus, 5 patients (45.45%) had persistent hypoglobus in the immediate postoperative period which reduced to 4 patients (36.36%) at 6 weeks postoperatively (p value .00). The postoperative orbital volume of fractured side ranged from 20.3 cm3 to 26.76 cm3 with a mean of 23.50 cm3 ± 1.74. The mean difference between the volumes of the repaired and uninjured sides was found to be .27 cm3 ± .39 (P value .02) denoting that the reconstruction of the orbit closely approximated that of the uninjured side. Conclusions The Matrixmidface Preformed Orbital plate provides exceptional reconstruction of the orbital blowout fracture defects and ensures satisfactory results clinically and radiographically. The plate ensures an approximate recreation of topographical anatomy of the orbit and adequately restores the orbital volume. It provides adequate correction of asymmetry, hypoglobus, enophthalmos and attempts to restore eye movements, without causing any significant postoperative complication.
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Affiliation(s)
- Neha Umakant Chodankar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, India
| | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, India
| | - Francis Akkara
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, India
| | - Vathsalya Vijay
- Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, India
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Vasile VA, Pirvulescu RA, Iancu RC, Garhöfer G, Schmetterer L, Ghita AM, Ionescu D, Istrate S, Piticescu RM, Cursaru LM, Popa-Cherecheanu A. Titanium Implants Coated with Hydroxyapatite Used in Orbital Wall Reconstruction-A Literature Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1676. [PMID: 38612189 PMCID: PMC11012370 DOI: 10.3390/ma17071676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
With the increasing incidences of orbital wall injuries, effective reconstruction materials and techniques are imperative for optimal clinical outcomes. In this literature review, we delve into the efficacy and potential advantages of using titanium implants coated with nanostructured hydroxyapatite for the reconstruction of the orbital wall. Titanium implants, recognized for their durability and mechanical strength, when combined with the osteoconductive properties of hydroxyapatite, present a potentially synergistic solution. The purpose of this review was to critically analyze the recent literature and present the state of the art in orbital wall reconstruction using titanium implants coated with nanostructured hydroxyapatite. This review offers clinicians detailed insight into the benefits and potential drawbacks of using titanium implants coated with nanostructured hydroxyapatite for orbital wall reconstruction. The highlighted results advocate for its benefits in terms of osseointegration and provide a novel strategy for orbital reconstruction, though further studies are essential to establish long-term efficacy and address concerns.
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Affiliation(s)
- Victor A. Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Ruxandra A. Pirvulescu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Raluca C. Iancu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore 637459, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4056 Basel, Switzerland
| | - Aurelian M. Ghita
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Diana Ionescu
- Department of ENT, Children’s Clinical Hospital “Dr. V. Gomoiu”, 022102 Bucharest, Romania
| | | | - Roxana M. Piticescu
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Laura M. Cursaru
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Alina Popa-Cherecheanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
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Hardisty M, Wei YT, Hontscharuk R, Ibrahimi A, Antonyshyn O, Edwards G, Mainprize JG, Whyne CM. Accuracy of Orbital Shape Reconstruction-Comparative Analysis of Errors in Implant Shape Versus Implant Positioning: A Cadaveric Study. J Craniofac Surg 2023; 34:1727-1731. [PMID: 37552131 DOI: 10.1097/scs.0000000000009566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/24/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Orbital blowout fractures are commonly reconstructed with implants shaped to repair orbital cavity defects, restore ocular position and projection, and correct diplopia. Orbital implant shaping has traditionally been performed manually by surgeons, with more recent use of computer-assisted design (CAD). Accuracy of implant placement is also key to reconstruction. This study compares the placement accuracy of orbital implants, testing the hypothesis that CAD-shaped implants indexed to patient anatomy will better restore orbit geometry compared with manually shaped implants and manually placed implants. METHODS The placement accuracy of orbital implants was assessed within a cadaveric blowout fracture model (3 skulls, 6 orbits) via 3-dimensional CT analysis. Defects were repaired with 4 different techniques: manually placed-manually shaped composite (titanium-reinforced porous polyethylene), manually placed CAD composite, indexed placed CAD composite, and indexed placed CAD titanium mesh. RESULTS Implant placement accuracy differed significantly with the implant preparation method ( P =0.01). Indexing significantly improved the placement accuracy ( P =0.002). Indexed placed titanium mesh CAD implants (1.42±0.33 mm) were positioned significantly closer to the intact surface versus manually placed-manually shaped composite implants (2.12±0.39 mm). DISCUSSION Computer-assisted design implants indexed to patient geometry yielded average errors below the acceptable threshold (2 mm) for enophthalmos and diplopia. This study highlights the importance of adequately indexing CAD-designed implants to patient geometry to ensure accurate orbital reconstructions.
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Affiliation(s)
- Michael Hardisty
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Physical Sciences, Sunnybrook Research Institute
- Department of Surgery
| | - Yuan Tao Wei
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Biomedical Engineering, University of Toronto
| | | | - Amani Ibrahimi
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
| | - Oleh Antonyshyn
- Department of Surgery
- Division of Plastic Surgery, Sunnybrook Health Sciences Centre
- Calavera Surgical Design, Toronto, Ontario, Canada
| | | | - James G Mainprize
- Physical Sciences, Sunnybrook Research Institute
- Calavera Surgical Design, Toronto, Ontario, Canada
| | - Cari M Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute
- Physical Sciences, Sunnybrook Research Institute
- Department of Surgery
- Biomedical Engineering, University of Toronto
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Wilkat M, Karnatz N, Schrader F, Schorn L, Lommen J, Parviz A, Möllmann HL, Rana M. Usage of Object Matching Algorithms Combined with Mixed Reality for Enhanced Decision Making in Orbital Reconstruction-A Technical Note. J Pers Med 2023; 13:922. [PMID: 37373911 DOI: 10.3390/jpm13060922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
This technical note describes the usage of object matching to virtually compare different modes of reconstruction in orbital trauma and display the results to the surgeon and the patient pre-operatively via mixed reality devices for enhanced surgical decision making and immersive patient education. A case of an orbital floor fracture is presented for which surface and volume matching were implemented to compare orbital reconstruction utilizing pre-fabricated titanium meshes versus patient-specific implants. The results could be visualized by mixed reality devices to further enhance surgical decision-making. The data sets were demonstrated to the patient in mixed reality for immersive patient education and enhanced shared decision making. The advantages of the new technologies are discussed in view of the new possibilities of improved patient education and informed consent processes, as well as new ways of teaching medical trainees.
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Affiliation(s)
- Max Wilkat
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Nadia Karnatz
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Felix Schrader
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Lara Schorn
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Julian Lommen
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Aida Parviz
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Henriette Louise Möllmann
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Majeed Rana
- Department of Oro-Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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Pietzka S, Wenzel M, Winter K, Wilde F, Schramm A, Ebeling M, Kasper R, Scheurer M, Sakkas A. Comparison of Anatomical Preformed Titanium Implants and Patient-Specific CAD/CAM Implants in the Primary Reconstruction of Isolated Orbital Fractures-A Retrospective Study. J Pers Med 2023; 13:jpm13050846. [PMID: 37241016 DOI: 10.3390/jpm13050846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND/AIM Reconstruction of the fractured orbit remains a challenge. The aim of this study was to compare anatomical preformed titanium orbital implants with patient-specific CAD/CAM implants for precision and intraoperative applicability. MATERIAL AND METHODS A total of 75 orbital reconstructions from 2012 to 2022 were retrospectively assessed for their precision of implant position and intra- and postoperative revision rates. For this purpose, the implant position after digital orbital reconstruction was checked for deviations by mirroring the healthy orbit at 5 defined points, and the medical records of the patients were checked for revisions. RESULTS The evaluation of the 45 anatomical preformed orbital implant cases showed significantly higher deviations and an implant inaccuracy of 66.6% than the 30 CAD/CAM cases with only 10% inaccuracy. In particular, the CAD/CAM implants were significantly more precise in medial and posterior positioning. In addition, the intraoperative revision rates of 26.6% vs. 11% after 3D intraoperative imaging and the postoperative revision rates of 13% vs. 0 for the anatomical preformed implants were significantly higher than for patient-specific implants. CONCLUSION We conclude that patient-specific CAD/CAM orbital implants are highly suitable for primary orbital reconstruction. These seem to be preferable to anatomical preformed implants in terms of precision and revision rates.
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Affiliation(s)
- Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Markus Wenzel
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, 04109 Leipzig, Germany
| | - Frank Wilde
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Alexander Schramm
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Marcel Ebeling
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Robin Kasper
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Mario Scheurer
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Andreas Sakkas
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
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Munoli A, Bhanushali J, Jagannathan M. Outcome of Precontoured Titanium Mesh in the Reconstruction of Orbital Blowout Fractures. Indian J Plast Surg 2023; 56:62-67. [PMID: 36998932 PMCID: PMC10049819 DOI: 10.1055/s-0043-1761597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background Orbital blowout fractures are peculiar injuries causing disruption of both ocular function and symmetry. We present our experience with the use of a precontoured titanium mesh in orbital blowout fractures.
Methods A retrospective study of patients undergoing correction of orbital blowout fractures with a precontoured titanium mesh was done at a tertiary care center in Mumbai. Data regarding demographics and pre- and postoperative clinical and radiological attributes were retrieved and compared.
Results A total of 21 patients (19 males and 2 females) underwent correction of blowout fractures with a precontoured titanium mesh. The follow-up period ranged from 6 to 10 months. Road traffic accident (76%) was the most common etiology. Twenty (95%) patients had impure blowout fractures and 1 (5%) patient had a pure blowout. The orbital floor was most commonly fractured (16 [76%]). Associated fractures of the zygomaticomaxillary complex were found in 71% of patients. All patients were operated on within 3 weeks of trauma. A comparison of the operated and uninjured sides on coronal views of computed tomography (CT) scan in nine patients by Photopea application revealed a correction of the increased cross-sectional area in all cases. Enophthalmos was completely corrected in 94% patients, while 92% patients had complete correction of diplopia. One patient with a comminuted zygomatic fracture had persistent diplopia and mild enophthalmos. Infraorbital paresthesia persisted in 58% patients at 6 months of follow-up. No significant postoperative complications were noted.
Conclusion The precontoured titanium mesh restores orbital wall anatomy and is safe, quick, fairly easy, and reproducible with a shorter learning curve. With proper patient selection and execution, prefabricated titanium mesh can serve as an excellent reconstructive option in blowout fractures of the orbit.
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Affiliation(s)
- Amarnath Munoli
- Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Jinisha Bhanushali
- Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Mukund Jagannathan
- Department of Plastic and Reconstructive Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Landau Prat D, Massarwa S, Zohar A, Priel A, Sagiv O, Zloto O, Ben Simon GJ. Patient-Specific Orbital Implants Vs. Pre-Formed Implants for Internal Orbital Reconstruction. Semin Ophthalmol 2023; 38:365-370. [PMID: 36639878 DOI: 10.1080/08820538.2023.2166353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare the outcome of orbital blowout fracture repair by means of pre-formed porous-polyethylene titanium implants (PFI) vs patient-specific porous-polyethylene implants (PSI). METHODS Retrospective cohort study. Baseline characteristics, ophthalmic examination results, ocular motility, fracture type, the timing of surgery, implant type, and final relative enophthalmos of all patients operated on for blow-out fractures in a single center were collected and analyzed. RESULTS Twenty-seven patients (mean age 39 years, 9 females) were enrolled. Sixteen underwent fracture repair with PFI and 11 with PSI at 11 months (median) post-trauma. Mean follow-up duration was 1.1 years. Both groups showed significant postoperative improvement in primary or vertical gaze diplopia (P = .03, χ2). Relative enophthalmos improved from -3.2 preoperative PFI to -1.7 mm postoperative PFI, and from -3.0 mm preoperative PSI to -1.1 mm postoperative PSI (P= .1). PSI patients had non-significantly less postoperative enophthalmos and globe asymmetry than PFI patients. The outcome was not influenced by previous surgery, age, sex, number of orbital walls involved in the initial trauma, or medial wall involvement (linear regression). Both groups sustained complications unrelated to implant choice. CONCLUSION Both PSI and PFI yielded good outcomes in this study. PSI may be a good alternative to PFI in primary or secondary orbital blowout fracture repair with less enophthalmos and globe asymmetry, in spite of the possible disadvantages of production time, a relatively larger design, and challenging insertion. Since it is a mirror image of the uninjured orbit, it may be beneficial in extensive fractures.
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Affiliation(s)
- Daphna Landau Prat
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center Tel Hashomer, Israel.,The Sheba Talpiot Medical Leadership Program, Sheba Medical Center Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Division of Ophthalmology, Oculoplastic and Orbital Surgery Service, The Children's Hospital of Philadelphia, and The Edwin and Fannie Gray Hall, Center for Human Appearance, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Said Massarwa
- Plastic Surgery Department, Hadassah Hospital, Jerusalem, Israel
| | - Assa Zohar
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center Tel Hashomer, Israel
| | - Ayelet Priel
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Oded Sagiv
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Ofira Zloto
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center Tel Hashomer, Israel.,The Sheba Talpiot Medical Leadership Program, Sheba Medical Center Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Guy J Ben Simon
- Orbital Ophthalmic Plastic & Lacrimal Surgery Institute, Goldschleger Eye Institute, Sheba Medical Center Tel Hashomer, Israel.,The Sheba Talpiot Medical Leadership Program, Sheba Medical Center Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Thumu SK, Vura N, Gaddipati R, Suvvada B. Management of Infraorbital Rim Fracture Through Intraoral Approach. J Maxillofac Oral Surg 2022; 21:911-915. [PMID: 36274875 PMCID: PMC9474754 DOI: 10.1007/s12663-021-01566-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose The aim of our study was to evaluate the feasibility of an intraoral approach in the management of infraorbital rim fracture. Patients and Methods A total of 12 patients of which four were female and five were male with isolated unilateral zygomaticomaxillary complex (ZMC) fractures, essentially involving the infraorbital foramen (right or left), were included in this study. Indications for surgical intervention were cosmetic deformity, disturbance of vision, persistent paresthesia, or impaired mandibular movement. All the patients were subjected to thorough preoperative evaluation. A three-point fixation was performed in all the patients. Various parameters such as time required for exposure and the amount of accessibility were assessed intraoperatively, while the stability of the fixation and paresthesia pertaining to the distribution of the infraorbital nerve were assessed postoperatively. Results A total of 12 patients with a mean age of 35.75 ± 12.7 years were included in the study. The mean time recorded for exposure and fixation was 21.33 ± 2.8 min. The accessibility was rated as "excellent" in 92% (11 patients) of the operated cases and rated "satisfactory" in 8% (1 patient) of the operated cases. The fixation was found to be stable in 100% of the cases. By the end of 8 months, normal mechanoreceptor response was elicited in 42% (five patients) of the cases and normal nocireceptor response was elicited in 92% (11 patients) of the cases. Conclusion The intraoral approach for fixation of the infraorbital rim is versatile and can be mastered even by novice surgeons. The virtual lack of complications and short learning curve make this approach an invincible modus operandi in a surgeon's repertoire.
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Affiliation(s)
- Sai Kumar Thumu
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, GiriPrasad nagar, Khammam, Telangana 507002 India
| | - Nandagopal Vura
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, GiriPrasad nagar, Khammam, Telangana 507002 India
| | - Rajasekhar Gaddipati
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, GiriPrasad nagar, Khammam, Telangana 507002 India
| | - Bharathi Suvvada
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, GiriPrasad nagar, Khammam, Telangana 507002 India
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Soh HY, Sun Q, Hu LH, Wang Y, Mao C, Peng X, Zhang WB. Accuracy of globe-sparing orbital reconstruction using individually bent titanium mesh: A comparative study. J Plast Reconstr Aesthet Surg 2022; 75:1971-1978. [DOI: 10.1016/j.bjps.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/09/2021] [Accepted: 01/09/2022] [Indexed: 11/25/2022]
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10
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Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures. J Clin Med 2021; 10:jcm10245975. [PMID: 34945272 PMCID: PMC8708228 DOI: 10.3390/jcm10245975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The known preformed osteosynthesis plates for the midface are helpful tools for a precise and fast fixation of repositioned fractures. The purpose of the current study is to analyze the precision of newly developed prototypes of preformed osteosynthesis plates for the mandible. Methods: Four newly designed preformed osteosynthesis plates, generated by a statistical shape model based on 115 CT scans, were virtually analyzed. The used plates were designed for symphyseal, parasymphyseal, angle, and condyle fractures. Each type of plate has three different sizes. For analysis, the shortest distance between the plate and the bone surface was measured, and the sum of the plate-to-bone distances over the whole surface was calculated. Results: A distance between plate and bone of less than 1.5 mm was defined as sufficient fitting. The plate for symphyseal fractures showed good fitting in 90% of the cases for size M, and in 84% for size L. For parasymphyseal fractures, size S fits in 80%, size M in 68%, and size L in 65% of the cases. Angle fractures with their specific plate show good fitting for size S in 53%, size M in 60%, and size L in 47%. The preformed plate for the condyle part fits for size S in 75%, for size M in 85%, and for size L in 74% of the cases. Conclusion: The newly developed mandible plates show sufficient clinical fitting to ensure adequate fracture reduction and fixation.
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Hamwood J, Schmutz B, Collins MJ, Allenby MC, Alonso-Caneiro D. A deep learning method for automatic segmentation of the bony orbit in MRI and CT images. Sci Rep 2021; 11:13693. [PMID: 34211081 PMCID: PMC8249400 DOI: 10.1038/s41598-021-93227-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/15/2021] [Indexed: 12/23/2022] Open
Abstract
This paper proposes a fully automatic method to segment the inner boundary of the bony orbit in two different image modalities: magnetic resonance imaging (MRI) and computed tomography (CT). The method, based on a deep learning architecture, uses two fully convolutional neural networks in series followed by a graph-search method to generate a boundary for the orbit. When compared to human performance for segmentation of both CT and MRI data, the proposed method achieves high Dice coefficients on both orbit and background, with scores of 0.813 and 0.975 in CT images and 0.930 and 0.995 in MRI images, showing a high degree of agreement with a manual segmentation by a human expert. Given the volumetric characteristics of these imaging modalities and the complexity and time-consuming nature of the segmentation of the orbital region in the human skull, it is often impractical to manually segment these images. Thus, the proposed method provides a valid clinical and research tool that performs similarly to the human observer.
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Affiliation(s)
- Jared Hamwood
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia
| | - Beat Schmutz
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
- Metro North Hospital and Health Service, Jamieson Trauma Institute, Herston, QLD, 4029, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia
| | - Mark C Allenby
- Biofabrication and Tissue Morphology Laboratory, Centre for Biomedical Technologies, School of Mechanical Medical and Process Engineering, Queensland University of Technology (QUT), Herston, Qld, 4000, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology (QUT), Kelvin Grove, Qld, 4059, Australia.
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Schreurs R, Dubois L, Klop C, Beenen LFM, Habets PEMH, Maal TJJ, Becking AG. Surgical instrument to improve implant positioning in orbital reconstruction: a feasibility study. Br J Oral Maxillofac Surg 2021; 59:826-830. [PMID: 34256960 DOI: 10.1016/j.bjoms.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.
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Affiliation(s)
- R Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - L Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P E M H Habets
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T J J Maal
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC Location AMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Wang W, Namin A, Shokri T, Ducic Y. Customized Orbit and Frontal Bone Implants. Facial Plast Surg 2020; 36:711-714. [PMID: 33368126 DOI: 10.1055/s-0040-1721109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Orbitocranial reconstruction objectives include creation of a solid barrier between intracranial contents and the environment allowing restoration of physiologic homeostasis and restoration of aesthetic craniofacial contours. Historically, bone grafts have been used for reconstruction but were fraught with unpredictable resorption and imperfect contouring given the complex anatomy of the orbitofrontal bones. With advances in three-dimensional modeling technology, alloplastic custom implants in orbital and frontal bone reconstruction have allowed for rapid fixation reducing surgical times and improved cosmesis.
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Affiliation(s)
- Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Arya Namin
- Department of Otolaryngology Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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von Wilmowsky C, Schwertner M, Nkenke E, Moest T, Adler W, Ebker T. Use of CAD-based pre-bent implants reduces theatre time in orbital floor reconstruction: results of a prospective study. Br J Oral Maxillofac Surg 2020; 58:753-758. [DOI: 10.1016/j.bjoms.2019.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/23/2019] [Indexed: 11/27/2022]
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Intraoperative Image-Guided Navigation in Craniofacial Surgery: Review and Grading of the Current Literature. J Craniofac Surg 2019; 30:465-472. [PMID: 30640846 DOI: 10.1097/scs.0000000000005130] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Image-guided navigation has existed for nearly 3 decades, but its adoption to craniofacial surgery has been slow. A systematic review of the literature was performed to assess the current status of navigation in craniofacial surgery. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) systematic review of the Medline and Web of Science databases was performed using a series of search terms related to Image-Guided Navigation and Craniofacial Surgery. Titles were then filtered for relevance and abstracts were reviewed for content. Single case reports were excluded as were animal, cadaver, and virtual data. Studies were categorized based on the type of study performed and graded using the Jadad scale and the Newcastle-Ottawa scales, when appropriate. RESULTS A total of 2030 titles were returned by our search criteria. Of these, 518 abstracts were reviewed, 208 full papers were evaluated, and 104 manuscripts were ultimately included in the study. A single randomized controlled trial was identified (Jadad score 3), and 12 studies were identified as being case control or case cohort studies (Average Newcastle-Ottawa score 6.8) The most common application of intraoperative surgical navigation cited was orbital surgery (n = 36), followed by maxillary surgery (n = 19). Higher quality studies more commonly pertained to the orbit (6/13), and consistently show improved results. CONCLUSION Image guided surgical navigation improves outcomes in orbital reconstruction. Although image guided navigation has promise in many aspects of craniofacial surgery, current literature is lacking and future studies addressing this paucity of data are needed before universal adoption can be recommended.
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Cooper T, Schmutz B, Hsu E, Lynham A. Magnetic resonance imaging for three-dimensional printing of the bony orbit: is clinical use imminent? Int J Oral Maxillofac Surg 2019; 49:483-490. [PMID: 31402077 DOI: 10.1016/j.ijom.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/28/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.
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Affiliation(s)
- T Cooper
- Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - B Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - E Hsu
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - A Lynham
- School of Medicine, University of Queensland, Brisbane, Australia
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Fuessinger MA, Schwarz S, Neubauer J, Cornelius CP, Gass M, Poxleitner P, Zimmerer R, Metzger MC, Schlager S. Virtual reconstruction of bilateral midfacial defects by using statistical shape modeling. J Craniomaxillofac Surg 2019; 47:1054-1059. [DOI: 10.1016/j.jcms.2019.03.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/24/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022] Open
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18
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Does Orbital Volume Change Using the Mirror Technique Have a Correlation With Posttraumatic Enophthalmos? J Craniofac Surg 2019; 30:e369-e372. [DOI: 10.1097/scs.0000000000005414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Generation of customized orbital implant templates using 3-dimensional printing for orbital wall reconstruction. Eye (Lond) 2018; 32:1864-1870. [PMID: 30154573 DOI: 10.1038/s41433-018-0193-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe and evaluate a novel surgical approach to orbital wall reconstruction that uses three-dimensionally (3D) printed templates to mold a customized orbital implant. METHODS A review was conducted of 11 consecutive patients who underwent orbital wall reconstruction using 3D-printed customized orbital implant templates. In these procedures, the orbital implant was 3D pressed during surgery and inserted into the fracture site. The outcomes of this approach were analyzed quantitatively by measuring the orbital tissue volumes within the bony orbit using computed tomography. RESULTS All 11 orbital wall reconstructions (6 orbital floor and 5 medial wall fractures) were successful with no post operative ophthalmic complications. Statistically significant differences were found between the preoperative and post operative orbital tissue volumes for the affected orbit (24.00 ± 1.74 vs 22.31 ± 1.90 cm3; P = 0.003). There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction (22.01 ± 1.60 cm3 vs 22.31 ± 1.90 cm3; P = 0.182). CONCLUSION 3D-printed customized orbital implant templates can be used to press and trim conventional implantable materials with patient-specific contours and sizes for optimal orbital wall reconstruction. It is difficult to design an orbital implant that exactly matches the shape and surface of a blowout fracture site due to the unique 3D structure of the orbit. The traditional surgical method is to visually inspect the fracture site and use eye measurements to cut a two-dimensional orbital implant that corresponds to the anatomical structure of the fracture site. However, implants that do not fit the anatomical structure of a fracture site well can cause complications such as enophthalmos, diplopia and displacement of the implant.
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Dreizin D, Nam AJ, Hirsch J, Bernstein MP. New and emerging patient-centered CT imaging and image-guided treatment paradigms for maxillofacial trauma. Emerg Radiol 2018; 25:533-545. [PMID: 29922866 DOI: 10.1007/s10140-018-1616-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022]
Abstract
This article reviews the conceptual framework, available evidence, and practical considerations pertaining to nascent and emerging advances in patient-centered CT-imaging and CT-guided surgery for maxillofacial trauma. These include cinematic rendering-a novel method for advanced 3D visualization, incorporation of quantitative CT imaging into the assessment of orbital fractures, low-dose CT imaging protocols made possible with contemporary scanners and reconstruction techniques, the rapidly growing use of cone-beam CT, virtual fracture reduction with design software for surgical pre-planning, the use of 3D printing for fabricating models and implants, and new avenues in CT-guided computer-aided surgery.
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Affiliation(s)
- David Dreizin
- Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA.
| | - Arthur J Nam
- Division of Plastic Surgery, University of Maryland School of Medicine, 22 S Green St., Baltimore, MD, 21201, USA
| | - Jeffrey Hirsch
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Mark P Bernstein
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, New York, NY, 10016, USA
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Low-Cost 3D Printing Orbital Implant Templates in Secondary Orbital Reconstructions. Ophthalmic Plast Reconstr Surg 2017; 33:376-380. [PMID: 28230707 DOI: 10.1097/iop.0000000000000884] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Despite its increasing use in craniofacial reconstructions, three-dimensional (3D) printing of customized orbital implants has not been widely adopted. Limitations include the cost of 3D printers able to print in a biocompatible material suitable for implantation in the orbit and the breadth of available implant materials. The authors report the technique of low-cost 3D printing of orbital implant templates used in complex, often secondary, orbital reconstructions. METHODS A retrospective case series of 5 orbital reconstructions utilizing a technique of 3D printed orbital implant templates is presented. Each patient's Digital Imaging and Communications in Medicine data were uploaded and processed to create 3D renderings upon which a customized implant was designed and sent electronically to printers open for student use at our affiliated institutions. The mock implants were sterilized and used intraoperatively as a stencil and mold. The final implant material was chosen by the surgeons based on the requirements of the case. RESULTS Five orbital reconstructions were performed with this technique: 3 tumor reconstructions and 2 orbital fractures. Four of the 5 cases were secondary reconstructions. Molded Medpor Titan (Stryker, Kalamazoo, MI) implants were used in 4 cases and titanium mesh in 1 case. The stenciled and molded implants were adjusted no more than 2 times before anchored in place (mean 1). No case underwent further revision. CONCLUSIONS The technique and cases presented demonstrate 1) the feasibility and accessibility of low-cost, independent use of 3D printing technology to fashion patient-specific implants in orbital reconstructions, 2) the ability to apply this technology to the surgeon's preference of any routinely implantable material, and 3) the utility of this technique in complex, secondary reconstructions.
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22
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Three dimensional reconstruction of late post traumatic orbital wall defects by customized implants using CAD-CAM, 3D stereolithographic models: A case report. J Oral Biol Craniofac Res 2017; 7:212-218. [PMID: 29124002 DOI: 10.1016/j.jobcr.2017.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/12/2017] [Indexed: 11/21/2022] Open
Abstract
Aim Purpose of this case report is to highlight the precision and accuracy obtained with patient specific implants for orbital reconstruction designed on the basis of volumetric analysis of orbital computed tomographic scan (CT) scans using virtual planning, computerised designing and manufacturing and stereolithographic models to correct late post-traumatic orbital deformities such as enophthalmos and diplopia. Material and methods This case report describes a patient who visited our outpatient clinic for correction of enophthalmos and persistent diplopia in upward gaze, seven months post trauma. Three dimensional (3D) virtual treatment planning was carried out by using the 3D CT data. The unaffected orbit of the contralateral side was superimposed on the deformed orbit to highlight the defect and a customized implant was designed in the desired size and shape on the virtual model using computer aided designing and manufacturing (CAD-CAM) and milled in titanium mesh for precise anatomic orbital reconstruction. Results There was a marked improvement in both the diplopia in upward gaze and enophthalmos post surgery when the customized patient specific orbital implant was used. Conclusion The concept of using customized implant with the help of 3D virtual treatment planning, 3D stereolithographic models and CAD-CAM greatly improves the correction of extremely difficult late post-traumatic orbital deformities.
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Virtual Fitting, Selection, and Cutting of Preformed Anatomic Orbital Implants. Ophthalmic Plast Reconstr Surg 2017; 33:196-201. [DOI: 10.1097/iop.0000000000000700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sukegawa S, Kanno T, Shibata A, Matsumoto K, Sukegawa-Takahashi Y, Sakaida K, Furuki Y. Treatment of Orbital Fractures with Orbital-Wall Defects using Anatomically Preformed Orbital Wall Reconstruction Plate System. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | - Takahiro Kanno
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Akane Shibata
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | - Kenichi Matsumoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | | | - Kyosuke Sakaida
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
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25
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Peng MY, Merbs SL, Grant MP, Mahoney NR. Orbital fracture repair outcomes with preformed titanium mesh implants and comparison to porous polyethylene coated titanium sheets. J Craniomaxillofac Surg 2016; 45:271-274. [PMID: 28038883 DOI: 10.1016/j.jcms.2016.11.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Restoration of orbital volume after internal orbital fractures can prevent enophthalmos. A variety of allografts are commonly used including titanium mesh with and without porous polyethylene coating. Some controversy exists over the use of uncoated titanium mesh in the orbit. Newer products contoured to the three dimensional orbital anatomy aim to improve reestablishment of the complex orbital shape though studies of outcomes with their use are limited. METHODS A retrospective chart review was performed to evaluate surgical outcomes in all patients who underwent orbital fracture repair with DePuy/Synthes titanium MatrixMIDFACE prefabricated implants (PFTi) as compared with porous polyethylene/titanium hybrid implants (PPETi) including Stryker Medpor Titan, MTB, and BTB implants. Incidence of reoperation, diplopia, and movement restriction between PFTi and PPETi groups and the risk ratio of the above outcomes between implant types were compared. RESULTS A total of 464 orbital implants were reviewed. Patients were divided by implant type with 195 patients receiving a PFTi implant and 269 patients receiving PPETi implant. (PFTi) and 269 had placement of a porous polyethylene/titanium hybrid implant. Despite statistically significant increased probability of utilization in more complex and delayed fractures, the PFTi implant showed no significant difference in complication profile or reoperation rate compared to the more commonly used PPETi. CONCLUSIONS PFTi implants, designed to replicate the native orbital shape, have similar surgical outcomes and no difference in complication profile compared to standard porous polyethylene/titanium implants hybrid plates.
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Affiliation(s)
- Michelle Y Peng
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Shannath L Merbs
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Michael P Grant
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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Postoperative Improvement of Diplopia and Extraocular Muscle Movement in Patients With Reconstructive Surgeries for Orbital Floor Fractures. J Craniofac Surg 2016; 27:2043-2049. [DOI: 10.1097/scs.0000000000003192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Schreurs R, Dubois L, Becking AG, Maal TJJ. Quantitative Assessment of Orbital Implant Position--A Proof of Concept. PLoS One 2016; 11:e0150162. [PMID: 26939123 PMCID: PMC4777501 DOI: 10.1371/journal.pone.0150162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/10/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction In orbital reconstruction, the optimal location of a predefined implant can be planned preoperatively. Surgical results can be assessed intraoperatively or postoperatively. A novel method for quantifying orbital implant position is introduced. The method measures predictability of implant placement: transformation parameters between planned and resulting implant position are quantified. Methods The method was tested on 3 human specimen heads. Computed Tomography scans were acquired at baseline with intact orbits (t0), after creation of the defect (t1) and postoperatively after reconstruction of the defect using a preformed implant (t2). Prior to reconstruction, the optimal implant position was planned on the t0 and t1 scans. Postoperatively, the planned and realized implant position were compared. The t0 and t2 scans were fused using iPlan software and the resulting implant was segmented in the fused t2 scan. An implant reference frame was created (Orbital Implant Positioning Frame); the planned implant was transformed to the reference position using an Iterative Closest Point approach. The segmentation of the resulting implant was also registered on the reference position, yielding rotational (pitch, yaw, roll) as well as translational parameters of implant position. Results Measurement with the Orbital Implant Positioning Frame proved feasible on all three specimen. The positional outcome provided more thorough and accurate insight in resulting implant position than could be gathered from distance measurements alone. Observer-related errors were abolished from the process, since the method is largely automatic. Conclusion A novel method of quantifying surgical outcome in orbital reconstructive surgery was presented. The presented Orbital Implant Positioning Frame assessed all parameters involved in implant displacement. The method proved to be viable on three human specimen heads. Clinically, the method could provide direct feedback intraoperatively and could improve postoperative evaluation of orbital reconstructive surgery.
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Affiliation(s)
- Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam (AMC) and Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, the Netherlands
- 3D Laboratory, Academic Medical Centre of Amsterdam (AMC) and Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam (AMC) and Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Alfred G. Becking
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam (AMC) and Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas J. J. Maal
- 3D Laboratory, Academic Medical Centre of Amsterdam (AMC) and Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, the Netherlands
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Mommaerts MY, Büttner M, Vercruysse H, Wauters L, Beerens M. Orbital Wall Reconstruction with Two-Piece Puzzle 3D Printed Implants: Technical Note. Craniomaxillofac Trauma Reconstr 2015; 9:55-61. [PMID: 26889349 DOI: 10.1055/s-0035-1563392] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022] Open
Abstract
The purpose of this article is to describe a technique for secondary reconstruction of traumatic orbital wall defects using titanium implants that act as three-dimensional (3D) puzzle pieces. We present three cases of large defect reconstruction using implants produced by Xilloc Medical B.V. (Maastricht, the Netherlands) with a 3D printer manufactured by LayerWise (3D Systems; Heverlee, Belgium), and designed using the biomedical engineering software programs ProPlan and 3-Matic (Materialise, Heverlee, Belgium). The smaller size of the implants allowed sequential implantation for the reconstruction of extensive two-wall defects via a limited transconjunctival incision. The precise fit of the implants with regard to the surrounding ledges and each other was confirmed by intraoperative 3D imaging (Mobile C-arm Systems B.V. Pulsera, Philips Medical Systems, Eindhoven, the Netherlands). The patients showed near-complete restoration of orbital volume and ocular motility. However, challenges remain, including traumatic fat atrophy and fibrosis.
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Affiliation(s)
- Maurice Y Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium; Orthoface Clinic, Oost-Vlaanderen, Belgium
| | - Michael Büttner
- European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Herman Vercruysse
- European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Lauri Wauters
- European Face Centre, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
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Beck-Broichsitter BE, Acar C, Kandzia C, Jochens A, Wiltfang J, Becker ST. Reconstruction of the orbital floor with polydioxanone: a long-term clinical survey of up to 12 years. Br J Oral Maxillofac Surg 2015; 53:736-40. [PMID: 26051867 DOI: 10.1016/j.bjoms.2015.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/13/2015] [Indexed: 11/19/2022]
Abstract
Fractures of the orbital floor are common in injured patients, who often require operation to prevent complications and, among other materials, polydioxanone is widely used. The aim of this study was to evaluate the long-term outcomes of fractures of the orbital floor that had been reconstructed with polydioxanone foil. A total of 101 patients (73 men and 28 women) who had reconstruction of the orbital floor for defects of 2cm(2) or smaller with polydioxanone implants, over a mean (SD) time period of 8 (2) years were evaluated. Sensitivity of the infraorbital nerve, ocular motility, and diplopia were evaluated and correlated with perioperative values. Persistent hyperaesthesia was found in 15 patients, whereas in another 15 the hyperaesthesia recovered completely over time. Three patients had double vision during follow-up. Twenty patients with preoperative diplopia had no persistent double vision postoperatively, and 15 patients with disturbed ocular motility recovered completely. Two patients had persistently disturbed motility, and one patient had enophthalmos. There was a significant association between hyperaesthesia preoperatively and postoperatively (p= 0.005). In most patients reconstruction of the orbital floor with polydioxanone was successful. Long-term complications such as diplopia, compromised bulbar motility, and hyperaesthesia of the cheek were seen in a few cases, but might not have been solely related to the use of polydioxanone.
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Affiliation(s)
| | - Carolin Acar
- Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany.
| | - Christian Kandzia
- Schleswig-Holstein University Hospital, Department of Ophthalmology, Arnold-Heller-Straße 3, Haus 25, 24105 Kiel, Germany.
| | - Arne Jochens
- Schleswig-Holstein University Hospital, Institute of Medical Informatics and Statistics, Brunswiker Straße 10, 24105 Kiel, Germany.
| | - Jörg Wiltfang
- University Professor and Head of the Department, Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
| | - Stephan T Becker
- Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery, Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany.
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Abstract
The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patientspecific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. This review focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field.
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Affiliation(s)
- Jun-Jun Wei
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Radzi S, Uesugi M, Baird A, Mishra S, Schuetz M, Schmutz B. Assessing the bilateral geometrical differences of the tibia--are they the same? Med Eng Phys 2014; 36:1618-25. [PMID: 25271192 DOI: 10.1016/j.medengphy.2014.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/28/2014] [Accepted: 09/07/2014] [Indexed: 02/05/2023]
Abstract
Contralateral bones are often used in many medical applications but it is assumed that their bilateral differences are insignificant. Previous studies used a limited number of distance measurements in quantifying the corresponding differences; therefore, little is known about their bilateral 3D surface asymmetries. The aim of the study is to develop a comprehensive method to quantify geometrical asymmetries between the left and right tibia in order to provide first results on whether the contralateral tibia can be used as an equivalent reference. In this study, 3D bone models were reconstructed from CT scans of seven tibiae pairs, and 34 variables consisting of 2D and 3D measurements were measured from various anatomical regions. All 2D measurements, and lateral plateau and distal subchondral bone surface measurements showed insignificant differences (p>0.05), but the rest of the surfaces showed significant differences (p<0.05). Our results suggest that the contralateral tibia can be used as a reference especially in surgical applications such as articular reconstructions since the bilateral differences in the subchondral bone surfaces were less than 0.3mm. The method can also be potentially transferable to other relevant studies that require the accurate quantification of bone bilateral asymmetries.
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Affiliation(s)
- S Radzi
- Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD 4059, Australia
| | - M Uesugi
- Tsukuba Medical Centre, Tsukuba City 305-8558, Japan
| | - A Baird
- Radiology Department, Princess Alexandra Hospital, QLD 4102, Australia
| | - S Mishra
- Department of Science & Technology, Government of India, New Delhi 110016, India
| | - M Schuetz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD 4059, Australia; Trauma Services, Princess Alexandra Hospital, QLD 4102, Australia
| | - B Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD 4059, Australia.
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Magnetic Resonance Imaging: An Accurate, Radiation-Free, Alternative to Computed Tomography for the Primary Imaging and Three-Dimensional Reconstruction of the Bony Orbit. J Oral Maxillofac Surg 2014; 72:611-8. [DOI: 10.1016/j.joms.2013.08.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/30/2022]
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Markiewicz MR, Bell RB. Traditional and contemporary surgical approaches to the orbit. Oral Maxillofac Surg Clin North Am 2013; 24:573-607. [PMID: 23107428 DOI: 10.1016/j.coms.2012.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traditional orbital approaches are nearly a century old and still comprise the foundation of techniques used today. Computer-assisted planning and intraoperative navigation have recently been reported with more prevalence in the literature. The purpose of this article was to review commonly used approaches to the orbit: old and new.
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Affiliation(s)
- Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, 611 Southwest Campus Drive, SDOMS, Portland, OR 97239, USA
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34
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Gunarajah DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg 2013; 71:550-70. [PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/10/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults. MATERIALS AND METHODS A systematic search of the English literature was performed in the databases of PubMed, Cochrane Library, and EMBASE. The study selection process was adapted from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, and 55 articles complied with the study inclusion criteria. The primary outcome measures were diplopia, enophthalmos, graft extrusion/displacement, and infection related to the graft material. The secondary outcome measures were infraorbital paresthesia, orbital dystopia, orbital soft tissue entrapment, and donor-site complications. RESULTS Of 55 articles, 41 (74.5%) evaluated were retrospective case series, 9 (16.4%) were retrospective case-control studies, 3 (5.5%) were controlled trials, and 2 (3.6%) were prospective case series. Autogenous graft materials were predominantly used in 19 studies, alloplastic materials were used in 33 studies, and the remaining 3 articles reported on allogeneic materials. Overall, 19 different types of implant materials were used in 2,483 patients. Of 827 patients with diplopia before surgery, 151 (18.3%) had diplopia postoperatively. Of 449 patients with enophthalmos before surgery, 134 (29.8%) had enophthalmos postoperatively. Only 2 patients (0.1%) and 14 patients (0.6%) had graft extrusion/displacement and infection related to the graft material, respectively; alloplastic biomaterials were used in all of these cases. CONCLUSIONS All graft materials used were successful to variable degrees because all studies reported improvement in terms of the recorded outcome measures. A guideline for choice of implant material based on defect size was developed.
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Degala S, Shetty SK, Biddappa L. Reconstruction of Post-traumatic Internal Orbital Wall Defects with Titanium Mesh. J Maxillofac Oral Surg 2012; 12:418-23. [PMID: 24431881 DOI: 10.1007/s12663-012-0444-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 09/24/2012] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The management of orbital injuries is one of the most interesting and difficult areas in facial trauma. The improper reconstruction of the orbit frequently results in ophthalmic complications. Though a number of materials are available for use in orbital wall reconstruction, at present titanium mesh could be considered to be the ideal orbital floor repair material. MATERIALS AND METHODS The study involved patients with symptomatic zygomatico-orbital fractures requiring orbital wall reconstruction. Under general anaesthesia the floor of orbit was explored and reconstructed with contoured titanium mesh after repositioning of the entrapped orbital contents. The patients were on periodic follow-up for 6 weeks where clinical and radiographic data were recorded. RESULT Ten male patients age ranging from 22 to 53 years (mean 29.88 years) received titanium implants for impure orbital fractures (eight patients) and pure orbital floor fractures (two patients). The main cause of fractures was road traffic accidents. They also complained of enophthalmos (n = 7), diplopia (n = 4), infraorbital nerve paresthesia (n = 6), dystopia (n = 1) and epiphora (n = 2). No implant extrusion or infection was seen. The symptoms were corrected in six patients with enophthalmos, three with diplopia, four with infraorbital nerve paresthesia and all patients with epiphora. Dystopia persisted post-surgically in one patient. CONCLUSION Titanium orbital implants were used to confirm titanium as a useful repair material for orbital floor fractures. Their use leads to less morbidity as no donor site operation is needed. Also it provides favourable healing as it is biocompatible.
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Affiliation(s)
- Saikrishna Degala
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, India
| | - Sujith Kumar Shetty
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, India
| | - Lakshith Biddappa
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, India
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Lieger O, Schaller B, Kellner F, Messmer-Schai B, Iizuka T. Low-profile titanium mesh in the use of orbital reconstruction: A pilot study. Laryngoscope 2012; 122:982-91. [DOI: 10.1002/lary.23200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/07/2011] [Accepted: 12/21/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Olivier Lieger
- Department of Cranio-Maxillofacial Surgery, Hospital Luzern, Luzern, Switzerland.
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37
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Markiewicz MR, Dierks EJ, Potter BE, Bell RB. Reliability of Intraoperative Navigation in Restoring Normal Orbital Dimensions. J Oral Maxillofac Surg 2011; 69:2833-40. [DOI: 10.1016/j.joms.2010.12.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/21/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
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Markiewicz MR, Bell RB. The Use of 3D Imaging Tools in Facial Plastic Surgery. Facial Plast Surg Clin North Am 2011; 19:655-82, ix. [DOI: 10.1016/j.fsc.2011.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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39
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Mustafa SF, Evans PL, Bocca A, Patton DW, Sugar AW, Baxter PW. Customized titanium reconstruction of post-traumatic orbital wall defects: a review of 22 cases. Int J Oral Maxillofac Surg 2011; 40:1357-62. [PMID: 21885249 DOI: 10.1016/j.ijom.2011.04.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 04/21/2011] [Indexed: 10/17/2022]
Abstract
The authors present the clinical results of their method of customized reconstruction of orbital wall defects using titanium mesh or sheet. High resolution computed tomography (CT) data are imported and processed to create a three-dimensional (3D) image which is used to reconstruct the orbital defect. Mirror imaging of the air in the contralateral maxillary sinus is used to overcome artefact defects in the floor. A stereolithographic model is constructed, from which titanium mesh or sheet is shaped and sized to the required contours for implantation. Twenty-two patients were treated using this technique from 2003 to 2008. Postoperatively 10 patients reported early resolution of their diplopia. Six patients noticed significant improvement of their symptoms with mild residual diplopia in one direction only and at the extremes of gaze at final review. One patient required ocular muscle surgery. Enophthalmos resolved in eight of the nine cases. No patients developed enophthalmos or diplopia as a postoperative complication. The use of titanium mesh for orbital floor reconstruction has been shown to be safe and effective. Customized titanium implants accurately reproduce orbital contours thus restoring orbital volume. This reduces operative time and improves the functional and aesthetic outcomes of post-traumatic orbital reconstruction.
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Affiliation(s)
- S F Mustafa
- Maxillofacial Unit, Morriston Hospital, Swansea, Wales, UK.
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40
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Modern concepts in computer-assisted craniomaxillofacial reconstruction. Curr Opin Otolaryngol Head Neck Surg 2011; 19:295-301. [DOI: 10.1097/moo.0b013e328348a924] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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He D, Li Z, Shi W, Sun Y, Zhu H, Lin M, Shen G, Fan X. Orbitozygomatic fractures with enophthalmos: analysis of 64 cases treated late. J Oral Maxillofac Surg 2011; 70:562-76. [PMID: 21752509 DOI: 10.1016/j.joms.2011.02.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 01/07/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To present our treatment experience in delayed orbitozygomatic fracture with enophthalmos and compare the results of traditional surgery, navigation-guided surgery, and 3-dimensional (3D) model-guided surgery in the Departments of Oral and Maxillofacial Surgery and Ophthalmology, Shanghai Ninth People's Hospital, Shanghai, China. PATIENTS AND METHODS This is a retrospective review of a consecutive clinical case series. From 2008 to 2010, 64 patients diagnosed with delayed orbitozygomatic fractures with enophthalmos were treated in the departments. Computed tomography (CT) scan and ophthalmologic examination were performed before surgery. Traditional surgery and computer-assisted treatment (navigation and 3D model) were used for zygoma reduction. Three materials were applied for orbital reconstruction: hydroxyapatite (HA), porous polyethylene (Medpor; Porex Surgical Inc, Newnan, GA), and titanium mesh. Zygomatic reduction and globe projection of different treatment methods were evaluated by postoperative CT scan and clinical follow-up visits. RESULTS Thirty-nine cases with enophthalmos (mean, 4.96 mm) had traditional surgery for fracture reduction and orbital reconstruction, whereas the other twenty-five cases with enophthalmos (mean, 5.71 mm) had computer-assisted surgery consisting of 3D models to pre-bend the titanium mesh for orbital reconstruction and plates for fracture fixation (n = 25) and navigation-guided surgery (n = 11). Postoperative CT with 3D reconstruction showed good zygomatic reduction in 74.3% of the cases with traditional surgery, 85.7% with computer-assisted 3D models only, and 100% with navigation-guided surgery. In the traditional surgery group, 74.2% of the cases had good postoperative globe projection (≤2 mm), 19.4% had mild enophthalmos (≤3 mm), and 6.5% had moderate enophthalmos (≤4 mm). In the group undergoing computer-assisted 3D model surgery, 75% of the cases had good globe projection and 25% had mild enophthalmos. In the navigation-guided surgery group, 90.9% of the cases had good globe projection and 9.1% had mild enophthalmos. Titanium mesh was used for orbital reconstruction in 47 cases (among which, 12 combined with Medpor or HA), whereas 12 had Medpor only and 5 had HA only. Good globe projection was acquired in 74% of the cases with titanium mesh only, 83% with combined materials, 67% with Medpor only, and 20% with HA only. CONCLUSIONS Computer-assisted surgery can improve the treatment results of delayed orbitozygomatic fracture with enophthalmos. Navigation-guided surgery with a 3D model and titanium mesh with Medpor are the best ways to treat delayed orbitozygomatic fractures with severe enophthalmos.
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Affiliation(s)
- Dongmei He
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Momjian A, Heuberger J, Scolozzi P. [Post-traumatic orbital reconstruction comparing preformed versus non preformed titanium mesh plates]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2011; 112:145-50. [PMID: 21497362 DOI: 10.1016/j.stomax.2011.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 01/30/2011] [Accepted: 03/02/2011] [Indexed: 11/27/2022]
Abstract
AIM We compared, clinically and radiologically, the accuracy and reliability of two types of titanium mesh plates used for orbital reconstruction. The first were non-preshaped mesh plates (NPMP) and the second were three-dimensionally preformed mesh plates (PMP). METHODS Two groups were created, each including 15 patients treated with NPMP and the second formed by 15 patients treated with PMP. The volume of each orbit was computed from coronal CT-scans using the OsiriX medical imaging software (version 3.3.2, www.osirix-viewer.com). Measurements were done for both, healthy and reconstructed sides. The other studied parameters were: sex, age, fracture distribution, and complications (diplopia and enophthalmia). RESULTS The orbital volume difference between the reconstructed and the healthy contralateral side was not statistically significant in either group (NPMP: p=0.991 PMP: p=0.200). The mean orbital volume of reconstructed orbits was not statistically significant in either group (NPMP: 21.76 cm(3) and PMP: 20.28 cm(3), p=0.441). DISCUSSION There is no difference in orbital volume reconstructions measured by the OsiriX software between non-preshaped and three-dimensionally preformed titanium mesh plates.
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Affiliation(s)
- A Momjian
- Service de chirurgie maxillofaciale et de chirurgie buccale, département de chirurgie, hôpitaux universitaires de Genève, Geneva, Switzerland.
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Comparison of collagen membranes and polydioxanone for reconstruction of the orbital floor after fractures. J Craniofac Surg 2011; 21:1066-8. [PMID: 20613556 DOI: 10.1097/scs.0b013e3181e62c5f] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Orbital floor fractures, often combined with zygomatic fractures, are common fractures of the midface. Surgery of orbital fractures is done to free incarcerated or prolapsed orbital tissue and to restore the anatomic skeletal size of the orbit. Lyodura was a standard for the reconstruction of the orbital floor until cases of Creutzfeldt-Jakob disease were reported, so that polydioxanone (PDS) is widely used today. However, infections around the implant are reported. In a randomized controlled clinical study on 24 patients with orbital floor defects of approximately 1 cm, we evaluated the use of a collagen membrane compared with a PDS foil. Computed tomography controls and ophthalmologic examinations were performed after 6 months in 10 patients per group.Intraoperative complications occurred neither in the collagen membrane group nor in the PDS group. In case of orbital rim fractures, the collagen membrane could additionally cover these defects. Perioperatively and postoperatively, no complications such as infections were observed. After 6 months, computed tomography controls revealed a complete reposition of orbital tissue and even bone regeneration in both groups. Diplopia and hypoesthesia were completely reversed after half a year.Smaller defects (up to 1 cm) of the orbital floor can be restored with a PDS foil or a collagen membrane. However, for larger defects, stability may not be sufficient.
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Evaluation of the application of computer-aided shape-adapted fabricated titanium mesh for mirroring-reconstructing orbital walls in cases of late post-traumatic enophthalmos. J Oral Maxillofac Surg 2010; 68:2070-5. [PMID: 20605306 DOI: 10.1016/j.joms.2009.08.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Revised: 07/05/2009] [Accepted: 08/28/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE Computer-aided individually shape-adapted fabricated titanium mesh for the mirroring-reconstruction of the orbit is a promising method for the correction of post-traumatic enophthalmos. The purpose of this study was to evaluate the application of this technique and assess the treatment outcomes. PATIENTS AND METHODS Twenty-one patients with delayed treatment of unilateral impure orbital fracture and post-traumatic enophthalmos were included in this study. Computed tomography-based mirroring-reconstruction images of the orbit were obtained for each individual to fabricate anatomically adaptive titanium mesh by computer-aided design and computer-aided manufacturing techniques. After exposing the areas of orbital defect and reducing the herniated soft tissue, the titanium mesh was inserted to reconstruct the internal orbit with a mean deep extension of 29.33 mm. Measurements were performed to assess the change in the degree of enophthalmos and orbital volume before and after surgery. Paired samples t test and Pearson correlation coefficient were employed for statistical analysis. RESULTS Follow-up examinations revealed that the degree of enophthalmos decreased to less than 2 mm in 11 patients, 2 to 4 mm in 9 patients, and remained greater than 7 mm in 1 patient. Statistical analysis revealed that post-traumatic enophthalmos in this series was 4.05 +/- 2.02 mm, which was associated with an orbital volume increment of 6.61 +/- 3.63 cm(3), with a regression formula of enophthalmos = 0.446 x orbital volume increment + 2.406. Orbital reconstruction effected a orbital volume decrease of 4.24 +/- 2.41 cm(3) and enophthalmos correction of 2.01 +/- 1.46 mm, the regression formula being enophthalmos = 0.586 x orbital volume decrease + 0.508. After surgery, the degree of unresolved enophthalmos was 2.03 +/- 1.52 mm, and the retained orbital volume expansion was 2.23 +/- 2.86 cm(3), and the regression formula was enophthalmos = 0.494 x orbital volume expansion + 1.415. CONCLUSION Application of the individual fabricated titanium mesh for orbital reconstruction reduced the trauma-induced orbital volume increment by 65% and corrected 50% of severe late enophthalmos. Additional augmentation of orbital contents was required for further correction. The related treatment parameters were suggested.
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Bell RB. Computer planning and intraoperative navigation in cranio-maxillofacial surgery. Oral Maxillofac Surg Clin North Am 2010; 22:135-56. [PMID: 20159483 DOI: 10.1016/j.coms.2009.10.010] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Preoperative computer design and stereolithographic modeling combined with intraoperative navigation provide a useful guide for and possibly more accurate reconstruction of a variety of complex cranio-maxillofacial deformities. Although probably not necessary for routine use, the author's early experience confirms that of other surgeons with more than a decade of experience: computer-assisted surgery is indicated for complex posttraumatic or postablative reconstruction of the orbits, cranium, maxilla, and mandible; total temporomandibular joint replacement; orthognathic surgery; and complex dental/craniofacial implantology. Further study is needed to provide outcomes data and cost-benefit analyses for each of these indications.
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Affiliation(s)
- R Bryan Bell
- Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital and Health Center, Head and Neck Surgical Associates, Oregon Health & Science University, 1849 NW Kearney, Suite 300, Portland, OR 97209, USA.
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Computer-Aided Volumetric Comparison of Reconstructed Orbits for Blow-Out Fractures With Nonpreformed Versus 3-Dimensionally Preformed Titanium Mesh Plates. J Comput Assist Tomogr 2010; 34:98-104. [DOI: 10.1097/rct.0b013e3181ac1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Computer-Assisted Planning, Stereolithographic Modeling, and Intraoperative Navigation for Complex Orbital Reconstruction: A Descriptive Study in a Preliminary Cohort. J Oral Maxillofac Surg 2009; 67:2559-70. [PMID: 19925972 DOI: 10.1016/j.joms.2009.07.098] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 05/01/2009] [Accepted: 07/26/2009] [Indexed: 11/23/2022]
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49
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S414: Computer-Assisted Planning and Navigation in Craniomaxillofacial Surgery. J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.joms.2009.05.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Accuracy and Predictability in Use of AO Three-Dimensionally Preformed Titanium Mesh Plates for Posttraumatic Orbital Reconstruction. J Craniofac Surg 2009; 20:1108-13. [DOI: 10.1097/scs.0b013e3181abb44b] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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