Low-profile titanium mesh in the use of orbital reconstruction: A pilot study

Facial defects reconstruction by titanium mesh bending using 3D printing technology: A report of two cases

Introduction

Facial injuries and deformities have received special attention during the previous decades for their functional, esthetic impairment, surgical challenges related to the location of the intervention, and their relationship to a lower survival rate. Moreover, there have been many surgical reconstructive methods due to the different materials and tools available and thus the final results following the surgical intervention.

Case presentation

This study was conducted on two patients with severe war injuries; they both suffered from a significant loss in one or more of the following bones: the zygomatic bone, maxilla, nasal bone, infraorbital rim, and mandible. They were treated using preshaped 3D titanium mesh implants that were made using polylactic acid (PLA) material. The final shape was identified depending on pregenerated multislice 3D modeling using computed tomography (CT) scan.

Clinical discussion and conclusion

The patient-specific titanium implants produced using polylactic acid (PLA) have been an important option for reconstructive surgical interventions in facial injuries. It has achieved a better outcome in comparison with manual bent titanium mesh in terms of anatomical symmetry, overall operating time, functional and esthetic impairment. These points helped achieve better care for both civilian and war injuries associated with bone loss.

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Facial injuries are of significant consideration especially during war time.

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Using titanium plates has increased due to its biocompatibility and rigid fixation.

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A printing model for the skull using polylactic acid is a successful approach.

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Pre-shaped mesh plates reveal better surgical outcomes.

Is there more to the clinical outcome in posttraumatic reconstruction of the inferior and medial orbital walls than accuracy of implant placement and implant surface contouring? A prospective multicenter study to identify predictors of clinical outcome

PURPOSE

Reconstruction of orbital wall fractures is demanding and has improved dramatically with the implementation of new technologies. True-to-original accuracy of reconstruction has been deemed essential for good clinical outcome, and reasons for unfavorable clinical outcome have been researched extensively. However, no detailed analysis on the influence of plate position and surface contour on clinical outcome has yet been published.

MATERIALS AND METHODS

Data from a previous study were used for an ad-hoc analysis to identify predictors for unfavorable outcome, defined as diplopia or differences in globe height and/or globe projection of >2 mm. Presumed predictors were implant surface contour, aberrant implant dimension or position, accuracy of reconstructed orbital volume, and anatomical fracture topography according to the current AO classification.

RESULTS

Neither in univariable nor in multivariable regression models were unfavorable clinical outcomes associated with any of the presumed radiological predictors, and no association of the type of implant, i.e., standard preformed, CAD-based individualized and non-CAD-based individualized with its surface contour could be shown.

CONCLUSION

These data suggest that the influence of accurate mechanical reconstruction on clinical outcomes may be less predictable than previously believed, while the role of soft-tissue-related factors may have been underestimated.

Anatomical Studies of the Orbital Cavity Using Three-Dimensional Computed Tomography

OBJECTIVE

This study was designed to analyze the morphometric characteristics of the orbital cavity using three-dimensional computed tomography in Asians.

METHODS

Two hundred seventy-six orbits in 142 Asians (74 men and 68 women) were examined and compared according to age, sex, and laterality (right and left).

RESULTS

Mean orbital morphometric values were as follows. Orbital cavity depth was 49.60 mm from optic foramen to orbitale (inferior) and 41.32 mm from optic foramen to lacrimal crest (medial). Anterior and posterior orbital medial wall heights were 17.73 and 12.76 mm, respectively. Medial, middle, and lateral orbital floor lengths were 39.08, 29.56, and 20.08 mm, respectively. Anterior and posterior orbital floor width was 21.87 and 12.00 mm, respectively. For the orbital inferior-medial angle, anterior, middle, and posterior value was 132.11°, 126.24°, and 136.88°, respectively. Inferior orbital cavity depth, anterior orbital medial wall height, and orbital floor length tended to increase with aging, whereas orbital floor width tended to decrease with aging. No significant differences were found in terms of laterality, and values were greater in men than in women.

CONCLUSIONS

This quantitative analysis of orbital measurements will allow surgeons to plan operations more accurately and will help predict outcomes.

Inaugural Survey on Practice Patterns of Orbital Floor Fractures for American Oral and Maxillofacial Surgeons

PURPOSE

In recent years, several studies have reported on practitioners' preferences for the treatment of orbital floor fractures, showing widely varying practice patterns. The purpose of the present study was to identify the practice patterns among oral and maxillofacial surgeons involved in the management of orbital floor fractures in the United States and compare them with the available published data.

MATERIALS AND METHODS

An anonymous survey was created and electronically mailed to surgeons. We also reviewed the published data on orbital floor fractures using a PubMed and MEDLINE search. The responses to the survey were analyzed using descriptive statistics.

RESULTS

The factors that had the greatest influence on the surgeon's decision to operate were a defect size > 2 cm2, enophthalmos, entrapment, and persistent diplopia. The most common surgical approach reported was a preseptal transconjunctival approach (32.0%), followed by the subciliary (27.9%) and postseptal transconjunctival (26.2%) approaches. The most commonly reported implant for orbital reconstruction was titanium (65.4%), followed by Medpor (43.7%) and composite Medpor and titanium (26.4%). The review of the published data showed a consensus among many of the operative indications mentioned, including a large defect size, enophthalmos, clinical entrapment, and persistent diplopia.

CONCLUSIONS

Oral and maxillofacial surgeons in the United States have a wide range of practice habits in the management of orbital floor fractures. Although the quality of the available evidence is poor, it supports a consistent approach to the management of orbital floor fractures in terms of the indications and surgical approach. The choice of reconstructive material and timing of repair remain more controversial. A clear need exists for improvement in the available data to help guide and set standards of care for the specialties managing orbital floor fractures.