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Kallaverja E, Barca I, Ferragina F, Cristofaro MG. Classical Orbital Floor Post-Traumatic Reconstruction vs. Customized Reconstruction with the Support of "In-House" 3D-Printed Models: A Retrospective Study with an Analysis of Volumetric Measurement. Diagnostics (Basel) 2024; 14:1248. [PMID: 38928663 PMCID: PMC11203151 DOI: 10.3390/diagnostics14121248] [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: 05/23/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. OBJECTIVE The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers ("In-House" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. MATERIALS AND METHODS The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. RESULTS From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the "Magna Graecia" University Hospital of Catanzaro 10 fulfilled the study's inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. CONCLUSION This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient's anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.
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Affiliation(s)
- Elvis Kallaverja
- Department of Experimental and Clinical Medicine, Maxillofacial Surgery Unit, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.K.); (F.F.)
| | - Ida Barca
- Department of Experimental and Clinical Medicine, Maxillofacial Surgery Unit, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Francesco Ferragina
- Department of Experimental and Clinical Medicine, Maxillofacial Surgery Unit, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.K.); (F.F.)
| | - Maria Giulia Cristofaro
- Department of Experimental and Clinical Medicine, Maxillofacial Surgery Unit, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.K.); (F.F.)
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D’Alpaos D, Badiali G, Ceccariglia F, Tarsitano A. Delayed Orbital Floor Reconstruction Using Mirroring Technique and Patient-Specific Implants: Proof of Concept. J Pers Med 2024; 14:459. [PMID: 38793041 PMCID: PMC11122088 DOI: 10.3390/jpm14050459] [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: 04/01/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3-6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction.
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Affiliation(s)
- Diana D’Alpaos
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
| | - Giovanni Badiali
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy
| | - Francesco Ceccariglia
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
| | - Achille Tarsitano
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy
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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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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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Pinto LAPF, Lima BC, Pinheiro GL, Rodrigues GGN. Late patient-fitted total orbital reconstruction for facial gunshot wound sequelae. Natl J Maxillofac Surg 2023; 14:326-329. [PMID: 37661981 PMCID: PMC10474548 DOI: 10.4103/njms.njms_85_22] [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: 05/27/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 09/05/2023] Open
Abstract
Late reconstructions of gunshot wounds (GSWs) in the orbital area are a true challenge to the oral and maxillofacial surgeon. Usually, the wall defects are large in size and commonly present loss of orbital volume, which can cause ocular dystopia. The only exceptions are when there is an explosion of the orbital walls-that is, blow-out fractures. We encountered a patient with a two-year sequelae after GSW in the face that caused the destructed orbit to have a 2.5 bigger size than the contralateral orbit, requiring meticulous planning of a patient-specific implant (PSI) to correctly reconstruct the orbit volume and bone projection. The PSI was developed using titanium and it had three pieces that could reconstruct all four walls of the orbit. After surgery, the patient regained orbital volume and malar projection, allowing him to benefit from facial symmetry. The PSI can be used to reconstruct all the orbital walls in cases of complex bone defects.
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Affiliation(s)
- Leonardo A. P. F. Pinto
- Oral and Maxillofacial Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Centro de Tratamento da Face, Rio de Janeiro, RJ, Brazil
| | - Bernardo C. Lima
- Hospital da Boca, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Giulianna L. Pinheiro
- Master Student in Dental Clinics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Sharaf B, Leon DE, Wagner L, Morris JM, Salinas CA. Virtual Planning and 3D Printing in the Management of Acute Orbital Fractures and Post-Traumatic Deformities. Semin Plast Surg 2022; 36:149-157. [PMID: 36506274 PMCID: PMC9729060 DOI: 10.1055/s-0042-1754387] [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: 12/13/2022]
Abstract
Virtual surgical planning (VSP) and three-dimensional (3D) printing have advanced surgical reconstruction of orbital defects. Individualized 3D models of patients' orbital bony and soft tissues provide the surgeon with corrected orbital volume based on normalized anatomy, precise location of critical structures, and when needed a better visualization of the defect or altered anatomy that are paramount in preoperative planning. The use of 3D models preoperatively allows surgeons to improve the accuracy and safety of reconstruction, reduces intraoperative time, and most importantly lowers the rate of common postoperative complications, including over- or undercontouring of plates, orbital implant malposition, enophthalmos, and hypoglobus. As 3D printers and materials become more accessible and cheaper, the utility of printing patient-specific implants becomes more feasible. This article summarizes the traditional surgical management of orbital fractures and reviews advances in VSP and 3D printing in this field. It also discusses the use of in-house (point-of-care) VSP and 3D printing to further advance care of acute orbital trauma and posttraumatic deformities.
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Affiliation(s)
- Basel Sharaf
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel E. Leon
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lilly Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jonathan M. Morris
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, Minnesota
| | - Cristina A. Salinas
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota,Address for correspondence Basel Sharaf, MD, DDS, FACS Division of Plastic surgery, Department of Surgery, Mayo Clinic200 First Street SW, Rochester, MN 55905
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Piombino P, Troise S, Maglitto F, Barone S, Sani L, Committeri U, Norino G, Bonavolontà P, Salzano G, Vaira LA, De Riu G, Califano L. Management of Orbital Floor Fractures: Our Experience in 10 Years. Indian J Otolaryngol Head Neck Surg 2022; 74:547-554. [PMID: 36514430 PMCID: PMC9741679 DOI: 10.1007/s12070-022-03127-9] [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: 12/26/2021] [Accepted: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Orbital floor Fractures are the most common fractures involving the facial skeleton and usually occurs after traumatic events. The reconstruction of the orbital floor can be performed with different biocompatible materials. The aim of our retrospective study is to analyze the short- and long-term outcomes of surgically treated patients based on the material used to repair the orbital floor. Methods We enrolled 146 patients hospitalized for orbital floor fractures in the Maxillofacial Surgery Unit of the Federico II University of Naples from 1 to 2010 to July 2020. All the fractured orbital floors were reconstructed with non-resorbable (Titanium Mesh, SynPor, SuPor and MedPor implants) or resorbable (collagen membrane, bovinum pericardium membrane, autologous bone graft) materials. Results We utilized non-resorbable materials in 56% (82 cases) and resorbable implants in 44% (64 cases). An improvement of the preoperative symptomatology and an aesthetical good outcome was achieved in most cases. Conclusions Data obtained supports that both resorbable and non-resorbable materials for orbital floor reconstruction are a safe and effective alternatives and offer satisfactory results in functional and aesthetic evaluations.
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Affiliation(s)
- Pasquale Piombino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Stefania Troise
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Fabio Maglitto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Simona Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Lorenzo Sani
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Umberto Committeri
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanna Norino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Paola Bonavolontà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Salzano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Luigi Califano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
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Chattopadhyay C, Dev V, Pilania D, Harsh A. Reconstruction of Orbital Floor Fractures with Titanium Micromesh: Our Experience. J Maxillofac Oral Surg 2022; 21:369-378. [DOI: 10.1007/s12663-020-01407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022] Open
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Kotecha S, Ferro A, Harrison P, Fan K. Orbital reconstruction: a systematic review and meta-analysis evaluating the role of patient-specific implants. Oral Maxillofac Surg 2022:10.1007/s10006-022-01074-x. [PMID: 35589881 DOI: 10.1007/s10006-022-01074-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/09/2022] [Indexed: 01/15/2023]
Abstract
The purpose of this study is to execute an evidence-based review answering the following question (PICO): "Do patient-specific implants (PSI), manufactured or designed using computer-assisted technology, improve outcomes (orbital volume change, enophthalmos, diplopia, and operative duration) compared to conventional methods in orbital reconstruction following traumatic orbital injury in the adult patient population?" We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. Inclusion criteria included any comparative paper whereby computer-assisted technology was used in the prefabrication or design process of implants for use in post-traumatic orbital reconstruction. Paediatric patient populations were excluded. Eight databases were systematically searched for relevant studies. Risk of bias was assessed through the NOS and RoB2 tools. Random-effects models were used to identify differences in outcomes between groups where possible. Analysis was performed using R 4.0.0. Eleven of 4784 identified studies were included, comprising 628 adult patients, with 302 and 326 patients in the patient-specific and conventional groups, respectively. Weighted mean difference between unaffected and post-operative orbital volume was 0.32 ml (SD 0.75) and 0.95 ml (SD 1.03) for patient-specific and conventional groups, respectively. Significant improvement was identified in post-operative orbital volume reconstitution with the use of PSI, compared to conventional implants, in 3 of the 5 reporting studies. Equally, post-operative enophthalmos trended towards lower severity in the patient-specific group, with 11.2% of patients affected in the patient-specific group and 19.2% in the conventional group, and operative duration was significantly reduced with the use of PSI in 3 of the 6 reporting studies. Despite a tendency to favour PSI, no statistically significant differences in key outcomes were identified on meta-analysis. Although there is some encouraging data to support improved outcomes with the use of patient-specific orbital implants in post-traumatic reconstruction, there is, at present, no statistically significant evidence to objectively support their use over conventional implants based on the currently available comparative studies. Based on the results of this study, the choice of implant used should, thus, be left to the discretion of the surgeon.
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Affiliation(s)
- Sanjeev Kotecha
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK. .,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK.
| | - Ashley Ferro
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
| | - Patrick Harrison
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
| | - Kathleen Fan
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, London, UK.,Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
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Sigron GR, Barba M, Chammartin F, Msallem B, Berg BI, Thieringer FM. Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models. J Clin Med 2021; 10:jcm10163509. [PMID: 34441806 PMCID: PMC8397200 DOI: 10.3390/jcm10163509] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/16/2023] Open
Abstract
The present study aimed to analyze if a preformed "hybrid" patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture's shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called "hybrid" patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when "hybrid" patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery's timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.
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Affiliation(s)
- Guido R. Sigron
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
- Correspondence: ; Tel.: +41-(0)61-265-73-44
| | - Marina Barba
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Frédérique Chammartin
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland;
| | - Bilal Msallem
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Britt-Isabelle Berg
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (M.B.); (B.M.); (B.-I.B.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
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Nazimi AJ, Nabil S. Intraoperative Computed Tomography Image Fusion for Orbital Blowout Fracture Reconstruction. ARCHIVES OF OROFACIAL SCIENCES 2021; 16:1-12. [DOI: 10.21315/aos2021.16.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Intraoperative computed tomography (CT) has been previously described and acknowledged for its use in orbital blowout fracture reconstructions. We described a clinical case series managed by this technique combined with intraoperative image fusion for accuracy in orbital implant position. In total, eight patients who sustained a total number of 19 orbital wall fractures were described. From the total number of 19 blowout orbital fracture reconstructions comprised of medial and inferior (floor) orbital fractures, malposition was identified in a total of four orbital implants by using image fusion. All cases of implant malposition were immediately revised intraoperatively. Subsequent fusion was carried out to confirm whether the revision was satisfactorily achieved. We found that the intraoperative image fusion technique utilised to determine orbital implant position, especially at the posterior ledge, further augmented the role of intraoperative CT scanning. Image fusion conceptually provides an immediate, real-time, and objective solution for intraoperative image analysis and potentially eliminates problems with misaligned CT images. It also reduces the need for the surgeon to ‘eye-ball’ the CT images acquired or the need for additional intraoperative time, since the patient’s head orientation is always axially at random during the acquisition of the CT. Conventional methods for CT image assessment are subjected to one’s own interpretation and may introduce inconsistent or longer intraoperative decision-making. The technique facilitates intraoperative decision-making and reduces the risk of orbital implant malposition in orbital blowout fracture reconstructions. Hence, surgical complication in relation to orbital implant malposition in orbital blowout fracture management could be minimised. In addition, no further postoperative imaging is required.
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Affiliation(s)
- Abd Jabar Nazimi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Syed Nabil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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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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Functional and Aesthetic Outcome of Extensive Orbital Floor and Medial Wall Fracture via Navigation and Endoscope-assisted Reconstruction. Ann Plast Surg 2020; 82:S77-S85. [PMID: 30516560 DOI: 10.1097/sap.0000000000001700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Extensive orbital floor and medial wall fractures compared with isolated orbital wall fractures are more likely to require surgical correction because of a higher possibility of complications like diplopia, enophthalmos, or numbness. The unique and complex contours of the orbital anatomy limit the intraoperative view of the intraorbital anatomy, and complex orbital fractures involving the buttress of the transition zone area all make orbital reconstruction surgery more challenging. The aim of this study was to describe our experience with surgical approaches using navigation- and endoscope-assisted guidance for extensive orbital floor and medial wall fracture reconstruction. PATIENTS AND METHODS A retrospective study was conducted on consecutive 17 patients from 2015 to 2017 presenting with unilateral extensive orbital floor and medial wall fractures at the Chang Gung Memorial Hospital, Linkou Branch. The fractures were treated surgically with a preformed mesh plate and layered Medpor (Porex Surgical Inc, Atlanta, Ga) through navigation and endoscopy. The preoperative and postoperative functional and aesthetic outcomes were described. RESULTS All extensive orbital floor and medial wall fractures were successfully reconstructed. Of the 17 patients, 11 experienced diplopia preoperatively, and for 2 of the 11 patients, diplopia improved immediately after surgery. In the remaining 9 patients, diplopia still persisted after surgery; however, diplopia recovered after an average of 3.44 months (range, 1-9 months). Average enophthalmos among the 10 patients, evaluated by postoperative follow-up computed tomography scan, improved from 2.99 to 0.68 mm. There were no major complications during follow-up, and all patients were satisfied with their final appearance and function. CONCLUSIONS On the basis of the results, our surgical approach using preformed titanium mesh plates and Medpor under the assistance of navigation and endoscopy can be a safe, accurate, and effective method for the management of extensive orbital floor and medial wall fractures and clearly optimizes functional and aesthetic outcomes.
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Schneider M, Besmens IS, Luo Y, Giovanoli P, Lindenblatt N. Surgical management of isolated orbital floor and zygomaticomaxillary complex fractures with focus on surgical approaches and complications. J Plast Surg Hand Surg 2020; 54:200-206. [PMID: 32493085 DOI: 10.1080/2000656x.2020.1746664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zygomaticomaxillary complex (ZMC) and orbital blow out fractures are commonly encountered midfacial fractures that may result in aesthetic and functional impairment. This retrospective study reports on the surgical treatment and associated postoperative complications in our patient collective. We evaluated 100 patients who underwent open reduction and internal fixation of midfacial fractures between 2010 and 2015. Preoperative clinical features, surgical technique and postoperative complications were analyzed. Surgery was performed with a mean latency of 7 days after trauma. We used titanium mesh and polydioxanone sheets to reconstruct the orbital floor. Most ZMC fractures were stabilized with two point fixation with titanium plates. Preoperative symptoms were present in 70 patients (70%). Infraorbital hypesthesia occurred in 49 patients, diplopia in 41 patients and ocular motility impairment in 24 patients. Postoperative symptoms persisted during a mean follow-up time of 4.5 months in 47 patients (47%) showing infraorbital hypesthesia in 24%, diplopia in 17%, ectropion in 7% and ocular motility impairment in 4%. Complications requiring revision were retrobulbar hematoma 3% (n = 3), ectropion 3% (n = 3), diplopia 1% (n = 1), exophthalmos 1% (n = 1), implant dislocation 1% (n = 1), implant discomfort 2% (n = 2), persisting fracture dislocation 1% (n = 1). All patients recovered without significant impairment. Surgery is required in the majority of the patients with midfacial fractures. Among others ectropion is challenging due to its aesthetic and functional impact on patients. To prevent ectropion, additional canthopexy or the transconjunctival surgical approach are reasonable options in selected cases. Level of Evidence: Level V, descriptive study. AbbreviationsCTcomputed tomographyOForbital floorPDSpolydioxanoneORIFopen reduction and internal fixationZMCzygomaticomaxillary complex.
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Affiliation(s)
- Martina Schneider
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Inga S Besmens
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Yeda Luo
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nicole Lindenblatt
- Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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Self-Made Rapid Prototyping Technique for Orbital Floor Reconstruction: Showcases for Technical Description. J Craniofac Surg 2019; 30:2106-2110. [PMID: 31513039 DOI: 10.1097/scs.0000000000006004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Restoring the orbital cavity integrity in orbital floor defects is a challenging issue due to the anatomical complexity of the floor's surface. This is a showcase for technical description of a novel "in house" rapid prototyping protocol aimed to customize implant for orbital floor reconstruction. METHODS The authors present 4 cases to show our Computer-aided-design and Computer-aided-manufacturing digital workflow. The system was based on a 3D-printed press that; through a virtually designed mold, was used to conform a patient specific titanium mesh for orbital floor reconstruction. RESULTS The merging procedure analysis by iPlan Cranial 3.0 (Brainlab, Munich, Germany) highlighted a 0.71 ± 0.23 mm (P <0.05) discrepancy in a point-to-point superimposition between the digital planned reconstruction and the real in vivo result. CONCLUSIONS The authors expect that this technique will reduce operative time and cost however further study and larger series may better define the applicability in everyday surgical practice.
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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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Gellrich NC, Dittmann J, Spalthoff S, Jehn P, Tavassol F, Zimmerer R. Current Strategies in Post-traumatic Orbital Reconstruction. J Maxillofac Oral Surg 2019; 18:483-489. [PMID: 31624425 DOI: 10.1007/s12663-019-01235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Posttraumatic orbital reconstruction is one of the most fascinating fields in reconstructive craniomaxillofacial surgery. Hardly any other field in craniomaxillofacial surgery has changed so much in terms of diagnostics, biomaterial selection for reconstruction, surgical techniques including approaches and quality control. In particular, in the field of reconstructive orbital surgery all advances in modern medical treatment are summarized and represented. Reconstructive orbital surgery thus became the medical field spearheading all reconstructive surgical specialties in terms of use of DICOM-data, computer assistance, change towards patient-specific solutions and establishing digital workflows for adequate quality control during all phases of treatment, i.e. pre-, intra- and postoperative. With this paper, this evolutionary process shall be demonstrated as well as display the spirit of change that was necessary to optimize reconstructive orbital surgery and to improve medical care in all areas of reconstruction. Finally, reconstructive orbital surgery could prove to be a highly foreseeable field nowadays, thus giving the next generation of CMF-surgeons a huge opportunity to drive this topic further into the future.
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Affiliation(s)
| | - Jan Dittmann
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Simon Spalthoff
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Philipp Jehn
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Frank Tavassol
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Rüdiger Zimmerer
- Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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Improved Outcomes of Orbital Reconstruction With Intraoperative Imaging and Rapid Prototyping. J Oral Maxillofac Surg 2019; 77:1211-1217. [DOI: 10.1016/j.joms.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/22/2022]
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Surgical Treatment of Posttraumatic Ophthalmoplegia Through the Reconstruction of the Lateral Orbital Wall. J Craniofac Surg 2018; 28:e444-e446. [PMID: 28538072 DOI: 10.1097/scs.0000000000003634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Orbital fractures are injuries frequently related to traumas of the midface. These fractures can be associated with ocular lesions, ranging from small abrasions on the cornea to serious complications such as hyphema and ocular globe rupture. Diplopia and ophthalmoplegia are common findings in orbital fractures. They can be caused by mechanical factors as bone fragments or muscle imprisonment. The aim of this study was to report a case of a 40-year patient, male showing diplopia and ophthalmoplegia due to the orbital fracture. The patient was treated by general anesthesia. It was performed a supra orbital approach and the fragments were removed. A titanium mesh to restore the orbital anatomy was installed. After 40 days of follow-up, the patient has no aesthetic or functional complaints. In orbital traumas, the ophthalmological evaluation should be performed carefully aiming to avoid ocular sequelaes. In surgical patients, the surgery should be done as early as the clinical conditions permit, to restore the ocular function.
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Zimmerer RM, Gellrich NC, von Bülow S, Strong EB, Ellis E, Wagner MEH, Sanchez Aniceto G, Schramm A, Grant MP, Thiam Chye L, Rivero Calle A, Wilde F, Perez D, Bittermann G, Mahoney NR, Redondo Alamillos M, Bašić J, Metzger M, Rasse M, Dittman J, Rometsch E, Espinoza K, Hesse R, Cornelius CP. 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. J Craniomaxillofac Surg 2018. [PMID: 29530645 DOI: 10.1016/j.jcms.2018.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Rüdiger M Zimmerer
- Medizinische Hochschule Hannover, Mund-, Kiefer- und Gesichtschirurgie, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Nils-Claudius Gellrich
- Medizinische Hochschule Hannover, Mund-, Kiefer- und Gesichtschirurgie, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Sophie von Bülow
- Medizinische Hochschule Hannover, Mund-, Kiefer- und Gesichtschirurgie, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Edward Bradley Strong
- UC Davis Health System, Department of Otolaryngology-Head and Neck Surgery, 2521 Stockton Blvd., Suite 7200, Sacramento, CA 95817, CA, USA
| | - Edward Ellis
- University of Texas Health Science Center at San Antonio, Dept. of Oral and Maxillofacial Surgery, 7703 Floyd Curl Dr., San Antonio, TX 78229, TX, USA
| | - Maximilian E H Wagner
- Universitätsspital Zürich, Klinik für Mund-, Kiefer- und Gesichtschirurgie, Frauenklinikstrasse 24, 8091, Zürich, Switzerland
| | - Gregorio Sanchez Aniceto
- 12 de Octubre University Hospital, Cirurgia Maxillofacial, Av. De Cordoba s/n, 28041, Madrid, Spain
| | - Alexander Schramm
- Bundeswehrkrankenhauses Ulm, Department of Oral, Maxillofacial and Plastic Facial Surgery, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Michael P Grant
- Johns Hopkins Hospital, The Wilmer Eye Institute, 600 North Wolfe Street, Baltimore, MD 21287, MD, USA
| | - Lim Thiam Chye
- National University Hospital, Division of Plastic Surgery, Lower Kent Ridge Road, 119074, Singapore
| | - Alvaro Rivero Calle
- 12 de Octubre University Hospital, Cirurgia Maxillofacial, Av. De Cordoba s/n, 28041, Madrid, Spain
| | - Frank Wilde
- Bundeswehrkrankenhauses Ulm, Department of Oral, Maxillofacial and Plastic Facial Surgery, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Daniel Perez
- University of Texas Health Science Center at San Antonio, Dept. of Oral and Maxillofacial Surgery, 7703 Floyd Curl Dr., San Antonio, TX 78229, TX, USA
| | - Gido Bittermann
- Albert-Ludwigs-Universität, Mund-, Kiefer- und Gesichtschirurgie, Hugstetter Straße 55, 79106, Freiburg i.Br., Germany
| | - Nicholas R Mahoney
- Johns Hopkins Hospital, The Wilmer Eye Institute, 600 North Wolfe Street, Baltimore, MD 21287, MD, USA
| | - Marta Redondo Alamillos
- 12 de Octubre University Hospital, Cirurgia Maxillofacial, Av. De Cordoba s/n, 28041, Madrid, Spain
| | - Joanna Bašić
- Bundeswehrkrankenhauses Ulm, Department of Oral, Maxillofacial and Plastic Facial Surgery, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Marc Metzger
- Albert-Ludwigs-Universität, Mund-, Kiefer- und Gesichtschirurgie, Hugstetter Straße 55, 79106, Freiburg i.Br., Germany
| | - Michael Rasse
- Medizinische Universitätsklinik Innsbruck, Universitätsklinik für Mund- Kiefer- und Gesichtschirurgie, Zahn,- Mund- und Kieferheilkunde, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Jan Dittman
- Medizinische Hochschule Hannover, Mund-, Kiefer- und Gesichtschirurgie, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Elke Rometsch
- AO Foundation, AO Clinical Investigation and Documentation (AOCID), Stettbachstr. 6, 8600, Dübendorf, Switzerland.
| | - Kathrin Espinoza
- AO Foundation, AO Clinical Investigation and Documentation (AOCID), Stettbachstr. 6, 8600, Dübendorf, Switzerland
| | - Ronny Hesse
- Klinikum der LMU Muenchen, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Lindwurmstr. 2a, 80337, München, Germany
| | - Carl-Peter Cornelius
- Klinikum der LMU Muenchen, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Lindwurmstr. 2a, 80337, München, Germany
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Computer-Assisted Volumetric Analysis and Quantitatively Anophthalmic Orbit Reconstruction With Dorsalis Pedis Flap and Bone Graft. J Craniofac Surg 2017; 29:358-363. [PMID: 29283945 DOI: 10.1097/scs.0000000000004209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Current approaches to orbit reconstruction are based on the assumption of facial symmetry and surgeons' experiences, and the reconstructed orbits are not precise. Through computer-assisted volumetric quantitative analysis, the volume of the bony orbit, and the volume of the soft tissues in both the anophthalmic orbit and the contralateral orbit are calculated in 39 anophthalmic patients. The rib graft is used for orbit reconstruction; the dosalis pedis flap and lipo-injection were used for soft tissue reconstruction and skin socket reconstruction. The size and the shape of the rib graft and soft tissues were designed according to the volumetric analysis. The size and the shape of the skin socket were designed according to measurement during surgery. Asymmetry eye sockets with adequate size were created in the 37 patients. Two patients presented with a poor asymmetry with the contralateral orbit, and got gradual extrusion of the eye prosthesis 4 months after operation, which was because of necrosis of the flaps. The flaps were remedied by frontal island flap and skin grafting. Further surgeries, such as lipoinjection, lid surgery, and canthoplasty, were applied to improve the surgical results. The eye prostheses fitted well in all of the reconstructed sockets using this technique. Our studies suggest that the computer-assisted volumetric analysis technique combined with quantitative bone graft and dorsalis pedis flap transfer, ± lipoinjection proved to be an accurate method and a quality assurance for optimization of bony orbit, soft tissue and skin socket reconstruction, and promised a successful postoperative outcome for patients' functional and esthetic appearance.
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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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Kim YC, Jeong WS, Park TK, Choi JW, Koh KS, Oh TS. The accuracy of patient specific implant prebented with 3D-printed rapid prototype model for orbital wall reconstruction. J Craniomaxillofac Surg 2017; 45:928-936. [DOI: 10.1016/j.jcms.2017.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 11/15/2022] Open
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Zieliński R, Malińska M, Kozakiewicz M. Classical versus custom orbital wall reconstruction: Selected factors regarding surgery and hospitalization. J Craniomaxillofac Surg 2017; 45:710-715. [PMID: 28318927 DOI: 10.1016/j.jcms.2017.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/04/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Nowadays, in orbital wall reconstruction, maxillofacial surgeons have the possibility to treat patients in modern ways such as with individual implants. Nevertheless, conventional treatment including standard titanium mesh shaped during the surgical procedure is also widely used. The aim of this study was to compare the above methods of orbital wall reconstructions. MATERIALS AND METHODS In the first group (39 cases), patients were treated by means of computer-aided design/computer-aided manufacturing (CAD/CAM) milled individual implants made of ultra-high-molecular-weight polyethylene, dioxide zirconium and rapid prototyping titanium mesh pre-bent on an ABS model made by a three-dimensional (3D) printer. In the second group (54 cases), intraoperative bending of titanium mesh was implemented. RESULTS Ophthalmologic outcomes were the same in both groups. In patients who had greater destruction of the orbit, surgical procedures were longer regardless of the material used for individual implants (p < 0.05). Time of surgery was shorter in patients in whom individual implants were used. Intraoperative bleeding was higher in patients who were treated using intraoperative bending titanium mesh (p < 0.01). CONCLUSION Application of CAD/CAM techniques do not give better ophthalmologic results in reference center but improve patient condition postoperatively. For this reason, CAD/CAM is a safer treatment method for patients.
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Affiliation(s)
- Rafał Zieliński
- Department of Maxillofacial Surgery (Head: Prof. Marcin Kozakiewicz, DDS), Medical University of Lodz, 1st Haller pl., 90-647 Lodz, Poland.
| | | | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery (Head: Prof. Marcin Kozakiewicz, DDS), Medical University of Lodz, 1st Haller pl., 90-647 Lodz, Poland
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Rapid prototyped patient specific guiding implants in critical mandibular reconstruction. J Craniomaxillofac Surg 2017; 45:63-70. [DOI: 10.1016/j.jcms.2016.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/22/2016] [Accepted: 10/26/2016] [Indexed: 11/21/2022] Open
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Grob SR, Yoon MK. Innovations in Orbital Surgical Navigation, Orbital Implants, and Orbital Surgical Training. Int Ophthalmol Clin 2017; 57:105-115. [PMID: 28885250 DOI: 10.1097/iio.0000000000000188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Bhatti N, Kanzaria A, Huxham-Owen N, Bridle C, Holmes S. Management of complex orbital fractures. Br J Oral Maxillofac Surg 2016; 54:719-23. [DOI: 10.1016/j.bjoms.2016.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/27/2016] [Indexed: 11/17/2022]
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Is there an ideal implant for orbital reconstructions? Prospective 64-case study. J Craniomaxillofac Surg 2016; 44:1682-1688. [PMID: 27637477 DOI: 10.1016/j.jcms.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/17/2016] [Accepted: 08/08/2016] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to compare the effectiveness of porous polyethylene, titanium mesh, and castor oil-derived biopolymer randomized in orbital reconstructions of defects larger than 1 cm in length on the inferior and medial walls. A total of 63 patients (64 orbits) were evaluated to determine the presence of diplopia, enophthalmos ocular motility, and infraorbital nerve paraesthesia in both the preoperative and postoperative periods. The surgeons' opinions of the ease in handling the implants were also obtained after each procedure. The patients were divided into 3 groups: 17 received porous polyethylene, 21 received castor oil-derived biopolymer, and 26 received titanium mesh. In the preoperative period, 30 patients experienced enophthalmos, 11 experienced diplopia, and 12 experienced ocular motility. Ninety days after the orbital reconstruction, 6 cases of enophthalmos persisted, as did 2 cases of diplopia and 2 cases of ocular motility. Ten patients developed some type of postoperative complication. Material removal was required in only 1 case. Regardless of the size of the defect, the materials used were found to be effective for reconstructing orbital volume; they were also found to offer ease in handling and stabilization.
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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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Gradinaru S, Popescu LM, Piticescu RM, Zurac S, Ciuluvica R, Burlacu A, Tutuianu R, Valsan SN, Motoc AM, Voinea LM. Repair of the Orbital Wall Fractures in Rabbit Animal Model Using Nanostructured Hydroxyapatite-Based Implant. NANOMATERIALS 2016; 6:nano6010011. [PMID: 28344268 PMCID: PMC5302541 DOI: 10.3390/nano6010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 12/15/2022]
Abstract
Cellular uptake and cytotoxicity of nanostructured hydroxyapatite (nanoHAp) are dependent on its physical parameters. Therefore, an understanding of both surface chemistry and morphology of nanoHAp is needed in order to be able to anticipate its in vivo behavior. The aim of this paper is to characterize an engineered nanoHAp in terms of physico-chemical properties, biocompatibility, and its capability to reconstitute the orbital wall fractures in rabbits. NanoHAp was synthesized using a high pressure hydrothermal method and characterized by physico-chemical, structural, morphological, and optical techniques. X-ray diffraction revealed HAp crystallites of 21 nm, while Scanning Electron Microscopy (SEM) images showed spherical shapes of HAp powder. Mean particle size of HAp measured by DLS technique was 146.3 nm. Biocompatibility was estimated by the effect of HAp powder on the adhesion and proliferation of mesenchymal stem cells (MSC) in culture. The results showed that cell proliferation on powder-coated slides was between 73.4% and 98.3% of control cells (cells grown in normal culture conditions). Computed tomography analysis of the preformed nanoHAp implanted in orbital wall fractures, performed at one and two months postoperative, demonstrated the integration of the implants in the bones. In conclusion, our engineered nanoHAp is stable, biocompatible, and may be safely considered for reconstruction of orbital wall fractures.
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Affiliation(s)
- Sinziana Gradinaru
- Ophthalmology Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
| | | | | | - Sabina Zurac
- Pathology Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
| | - Radu Ciuluvica
- Anatomy Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
| | - Alexandrina Burlacu
- Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania.
| | - Raluca Tutuianu
- Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania.
| | | | - Adrian Mihail Motoc
- National R & D Institute for Non-ferrous and Rare Metals, 077145 Ilfov, Romania.
| | - Liliana Mary Voinea
- Ophthalmology Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
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Dai J, Shen G, Yuan H, Zhang W, Shen S, Shi J. Titanium Mesh Shaping and Fixation for the Treatment of Comminuted Mandibular Fractures. J Oral Maxillofac Surg 2015; 74:337.e1-337.e11. [PMID: 26529196 DOI: 10.1016/j.joms.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/01/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures. MATERIALS AND METHODS Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction-internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up. RESULTS Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis. CONCLUSIONS We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology.
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Affiliation(s)
- Jiewen Dai
- Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guofang Shen
- Professor, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Yuan
- Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenbin Zhang
- Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shunyao Shen
- Resident, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Shi
- Associate Professor, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Christensen BJ, Zaid W. Inaugural Survey on Practice Patterns of Orbital Floor Fractures for American Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg 2015; 74:105-22. [PMID: 26475972 DOI: 10.1016/j.joms.2015.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Brian J Christensen
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Waleed Zaid
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
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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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Controversies in orbital reconstruction—II. Timing of post-traumatic orbital reconstruction: A systematic review. Int J Oral Maxillofac Surg 2015; 44:433-40. [DOI: 10.1016/j.ijom.2014.12.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 11/24/2022]
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Rana M, Chui CHK, Wagner M, Zimmerer R, Rana M, Gellrich NC. Increasing the accuracy of orbital reconstruction with selective laser-melted patient-specific implants combined with intraoperative navigation. J Oral Maxillofac Surg 2015; 73:1113-8. [PMID: 25981837 DOI: 10.1016/j.joms.2015.02.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/11/2015] [Accepted: 02/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Advances in technology have allowed increasing degrees of accuracy in the treatment of orbital deformities. The purpose of this study was to compare the accuracy of pre-bent titanium mesh (PBTM) and selective laser-melted patient-specific implants (PSIs) in unilateral orbital reconstruction after traumatic injury. The authors hypothesized that selective laser-melted PSIs would more accurately reconstruct the orbit. MATERIALS AND METHODS A retrospective review of 34 cases of primary reconstruction of unilateral orbital fractures treated using selective laser-melted PSIs (group 1, n = 17) or PBTM (group 2, n = 17) was performed. The primary outcome measurements were orbital volume excess and the anterior, medial, and posterior intraorbital angles. The Mann-Whitney U test was used to assess the difference in orbital volume and angular deviation between the 2 groups. The level of statistical significance was set at .05. All P values were 2-sided. RESULTS The comparison of mean values for the 2 groups showed significant differences for the anterior angle (PBTM: mean, 11.3; standard deviation [SD], 1.8; PSI: mean, 4.1; SD, 0.7; P = .001), but not the medial (PBTM: mean, 11.6; SD, 2.0; PSI: mean, 8.2; SD, 1.9; P = .170) and posterior (PBTM: mean, 10.8, SD, 2.8; PSI: mean, 8.2, SD, 1.4; P = .760) angles between the unaffected and reconstructed orbits. The postoperative difference in volume between the unaffected and reconstructed orbits differed significantly between the 2 study groups (PBTM: mean, 0.6; SD, 0.1; PSI: mean, 0.4; SD, 0.1; P = .029). CONCLUSION The results of this study suggest that complex orbital fractures can be reconstructed with an even higher degree of accuracy with selective laser-melted PSIs than with PBTM.
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Affiliation(s)
- Majeed Rana
- Senior Consultant, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany.
| | - Christopher H K Chui
- Clinical Fellow, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Maximillian Wagner
- Resident, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Ruediger Zimmerer
- Resident, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Madiha Rana
- Associate Professor, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Professor and Department Head, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, 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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A new modification of the individually designed polymer implant visible in X-ray for orbital reconstruction. J Craniomaxillofac Surg 2014; 42:1520-9. [DOI: 10.1016/j.jcms.2014.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/15/2014] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
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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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Stoor P, Suomalainen A, Lindqvist C, Mesimäki K, Danielsson D, Westermark A, Kontio RK. Rapid prototyped patient specific implants for reconstruction of orbital wall defects. J Craniomaxillofac Surg 2014; 42:1644-9. [PMID: 25139812 DOI: 10.1016/j.jcms.2014.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/30/2022] Open
Abstract
Defects of orbital walls can be reconstructed using implants. The authors report a safe and accurate method to reconstruct bone defects in the orbital area using patient specific implants. A detailed process description of computer aided design (CAD) reconstructive surgery (CRS) is introduced in this prospective study. The 3D volumetric virtual implant was design using MSCT data and PTCProEngineer™ 3D software. The intact orbital cavity of twelve patients was mirrored to the injured side. Specific ledges steered the implant into correct place. Postoperatively the position was assessed using image fusion. One implant (8%) was rejected due to chemical impurities, two (16%) had a false shape due to incorrect CAD. Data of thin bone did not transfer correctly to CAD and resulted in error. One implant (8%) was placed incorrectly. Duration of the CRS was in average 1.17 h, correspondingly 1.57 h using intraoperative bending technique. The CRS process has several critical stages, which are related to converting data and to incompatibility between software. The CRS process has several steps that need further studies. The data of thin bone may be lost and disturb an otherwise very precise technique. The risk of incorporating impurities into the implant must be carefully controlled.
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Affiliation(s)
- Patricia Stoor
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Anni Suomalainen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Christian Lindqvist
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Karri Mesimäki
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Danielsson
- Department of Maxillofacial Surgery, Karolinska Sjukhuset, Stockholm, Sweden
| | - Anders Westermark
- Department of Maxillofacial Surgery, Ålands Sjukhuset, Mariehamn, Finland
| | - Risto K Kontio
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland.
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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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Evolution and trends in reconstructive facial surgery: an update. J Maxillofac Oral Surg 2013; 11:466-72. [PMID: 24293942 DOI: 10.1007/s12663-012-0363-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022] Open
Abstract
Surgical correction of congenital and acquired facial deformities has transcended the primitive era of using non biologic materials to current attempts at own face growing through biotechnology. A summative account of this trend is still lacking in the literature. The objective of this article is to present an update on current knowledge in the strides to achieve functionally and aesthetically perfect facial reconstruction. It highlights the impact of advancements in 3D imaging, stereolithographic biomodelling, microvascular surgical tissue transplantation and tissue biotechnology in the surgical efforts to solve the problems of facial disfigurement whether congenital or acquired.
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Kozakiewicz M, Szymor P. Comparison of pre-bent titanium mesh versus polyethylene implants in patient specific orbital reconstructions. Head Face Med 2013; 9:32. [PMID: 24382118 PMCID: PMC4029398 DOI: 10.1186/1746-160x-9-32] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/24/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction Computerized tomography DICOM file can be relatively easily transformed to a virtual 3D model. With the help of additional software we are able to create the mirrored model of an undamaged orbit and on this basis produce an individual implant for the patient Authors decided to apply implants with any thickness, which are authors own invention to obtain volumetric support and more stable orbital wall reconstruction outcome. Material of choice was ultra-high molecular weight polyethylene (UHMWPE). Objective The aim of this study was to present and compare functional results of individual reconstructions of orbital wall using either titanium mesh or ultra-high molecular weight polyethylene. Materials and methods 57 consecutive patients affected by orbital wall fracture (46 males, 11 females, mean age 34±14 year) were treated in Department of Maxillofacial Surgery from 2010 to 2012. In the first group we used patient specific treatment by titanium mesh shaped on a 3D printed model of a mirrored intact orbit (37 orbits) or by individually manufactured UHMW-PE implantby CAM milling in second group (20 orbits). All of these patients were subjected to preoperative helical computerized tomography and consultation of an ophthalmologist (including binocular single vision loss test - BSVL). Further on, patients were operated under general anaesthesia using transconjuctival approach. BSVL was again evaluated post-operationally in 1 month and 6 months later. Results Functional treatment results (BSVL) for both groups were similar in 1 month as well as 6 months post operational time. There was no statistically significant difference between these two groups. Conclusions This study of 6 months functional result assessment of pre-bent individual implants and CNC milled ultra-high molecular weight polyethylene of the orbital wall has shown it to be a predictable reconstruction method. Individually shaped UHMWPE seems to be as good as pre-bent titanium mesh.
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Kozakiewicz M. Computer-aided orbital wall defects treatment by individual design ultrahigh molecular weight polyethylene implants. J Craniomaxillofac Surg 2013; 42:283-9. [PMID: 23835569 DOI: 10.1016/j.jcms.2013.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022] Open
Abstract
UNLABELLED Despite of well-known advantages of high molecular weight polyethylene (Medpor, Synpore) in orbital reconstructions, the thickness of those implants significantly exceeds 0.5 mm and precise modification of thickness is limited. The aim of this study was to present the application of a self-developed method of treatment orbital wall fracture by custom implant made of ultrahigh molecular weight polyethylene (UHMW-PE). MATERIAL AND METHOD First, the test of influence of sterilization process upon implant deformation was performed (autoclaving, ethylene oxide, gas plasma, irradiation). Next, ten cases for delayed surgical treatment of orbital fracture were included into this study (7 males, 3 females). Based on CT scan and mirrored technique, a CAD model of virtual implant for repairing orbital wall was made. Then, an implant was manufactured with a computer numerical controlled milling machine from UHMW-PE block, sterilized and used during a surgical procedure. Clinically used implants had thickness from 0.2 to 4.0 mm. RESULTS The best method of sterilization is ethylene oxide process, and the worst is autoclaving. In this series of delayed surgical cases, functional results of orbital surgery are worse than in simpler, early treated cases, but long-term subsidence of diplopia is noticeable [10% poor results]. The results of the treatment depend on the initial level of diplopia where severe initial diplopia to be corrected requires thicker implants (p < 0.01). It also leads to longer surgical procedures (p < 0.01), but prolongation of the surgery had no negative influence upon results of any investigated follow-up examinations. Obviously, the orbital destruction intensity is related to injury-evoked initial diplopia but it also influences whole results of treatment up to 12 months post-op. Interesting result is presented by the relation of maximal implant thickness to 12-month diplopia evaluation. Thicker implants used result in lower residual diplopia (p < 0.05). This is important because of the correlation between the higher orbital destruction intensity with a thicker UHMW-PE implant (p < 0.05) applied in this series. CONCLUSION Patient-specific ultrahigh molecular weight polyethylene implants enable precise reconstructions of orbital wall. One should not be afraid of a significant eye globe reposition caused by these thickness modulated implants, as such repositioning is essential for an efficient correction of enophthalmos.
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Affiliation(s)
- Marcin Kozakiewicz
- Department of Maxillofacial Surgery (Head: Marcin Kozakiewicz, DDS, PhD), Medical University of Lodz, Zeromskiego 113, Lodz, Poland.
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Technical concept of patient-specific, ultrahigh molecular weight polyethylene orbital wall implant. J Craniomaxillofac Surg 2013; 41:282-90. [DOI: 10.1016/j.jcms.2012.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/20/2022] Open
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Cho RI, Davies BW. Combined orbital floor and medial wall fractures involving the inferomedial strut: repair technique and case series using preshaped porous polyethylene/titanium implants. Craniomaxillofac Trauma Reconstr 2013; 6:161-70. [PMID: 24436754 DOI: 10.1055/s-0033-1343785] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/14/2012] [Indexed: 10/26/2022] Open
Abstract
Background Combined orbital floor and medial wall fractures can be technically challenging to repair, particularly when the inferomedial strut is involved. A surgical repair technique is described utilizing a single preshaped porous polyethylene/titanium implant to span both defects. Methods Retrospective interventional case series. Results Fracture repair was performed on 17 orbits (16 patients) between October 2009 and February 2012. Subsequent surgical revision was required in three cases (18%). Visual acuity was stable or improved in all cases. Of 7 patients with preoperative diplopia, 5 improved and 2 remained stable postoperatively, and there were no cases of new or worsened diplopia following surgery. Postoperative asymmetry in Hertel exophthalmometry averaged 1.0 mm (range 0 to 2 mm). Preoperatively, average orbital volume was 122.7% compared with control (range 109 to 147%, standard deviation [SD] 9.6), which improved to 100.3% postoperatively (range 92 to 110%, SD 5.7). The average decrease in orbital volume was 22.5% (range 10 to 54%, SD 11.4, p < 0.001). Conclusions With careful preoperative planning and meticulous surgical technique, combined orbital floor and medial wall fractures involving the inferomedial strut can be successfully repaired with a preshaped porous polyethylene/titanium implant through a transconjunctival/transcaruncular approach with inferior oblique disinsertion.
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Affiliation(s)
- Raymond I Cho
- Oculoplastic and Orbital Surgery Service, San Antonio Military Medical Center
| | - Brett W Davies
- Department of Ophthalmology, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
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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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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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Ciocca L, Fantini M, De Crescenzio F, Corinaldesi G, Scotti R. CAD–CAM prosthetically guided bone regeneration using preformed titanium mesh for the reconstruction of atrophic maxillary arches. Comput Methods Biomech Biomed Engin 2013; 16:26-32. [DOI: 10.1080/10255842.2011.601279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gabrielli MF, Monnazzi MS, Passeri LA, Carvalho WR, Gabrielli M, Hochuli-Vieira E. Orbital wall reconstruction with titanium mesh: retrospective study of 24 patients. Craniomaxillofac Trauma Reconstr 2012; 4:151-6. [PMID: 22942944 DOI: 10.1055/s-0031-1286120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The aim of this study was to evaluate the efficacy and safety of traumatic orbital defect reconstruction with titanium mesh. A retrospective study was made. Evaluations were made after a minimum postoperative follow-up of 12 months, looking for the main complications. Twenty-four patients were included in this evaluation; 19 were male (79.1%) and 5 (20.8%) were female. The main injury etiology was vehicle accidents (50%) followed by other causes. Fourteen patients (58.3%) presented orbital floor fractures, and 10 had more than one wall fractured (41.6%). Permanent infraorbital nerve hypoesthesia was observed in two patients (8.3%), enophthalmos occurred in five patients (20.8%), and exophthalmos was found in two patients (8.3%). Four patients (16.6%) still presented evidence of residual prolapsed intraorbital content, and one of those needed further surgical correction; sinusitis occurred in one patient (4.1%). Titanium mesh is a reliable option for orbital reconstruction, despite some complications found in this sample.
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