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Tomic J, Wiederstein-Grasser I, Schanbacher M, Weinberg AM. Newly Developed Resorbable Magnesium Biomaterials for Orbital Floor Reconstruction in Caprine and Ovine Animal Models-A Prototype Design and Proof-of-Principle Study. J Funct Biomater 2023; 14:339. [PMID: 37504834 PMCID: PMC10381438 DOI: 10.3390/jfb14070339] [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: 04/21/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND orbital floor fractures have not been reconstructed using magnesium biomaterials. METHODS To test technical feasibility, ex vivo caprine and ovine heads (n = 5) were used. Head tissues were harvested from pubescent animals (n = 5; mean age: 3.2 years; mean mass: 26.3 kg) and stored below 11 degrees for 7-10 days. All procedures were performed in a university animal resource facility. Two experienced maxillofacial surgeons performed orbital floor procedures in both orbits of all animals in a step-by-step preplanned dissection. A transconjunctival approach was chosen to repair the orbital floor with three different implants (i.e., magnesium implants; titanium mesh; and polydioxanone or PDO sheets). The position of each implant was evaluated by Cone-beam computed tomography (CBCT). RESULTS Axial, coronal, and sagittal plane images showed good positioning of the magnesium plates. The magnesium plates had a radiographic visibility similar to that of the PDO sheets but lower than that of the titanium mesh. CONCLUSIONS The prototype design study showed a novel indication for magnesium biomaterials. Further testing of this new biomaterial may lead to the first resorbable biomaterial with good mechanical properties for extensive orbital wall defects.
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Affiliation(s)
- Josip Tomic
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Iris Wiederstein-Grasser
- Core Facility Experimental Biomodels, Division of Biomedical Research, Medical University of Graz, 8036 Graz, Austria
| | - Monika Schanbacher
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Annelie Martina Weinberg
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Taxis J, Ungerboeck L, Gehrking MR, Motel C, Wurm M, Eckert AW, Spanier G, Nieberle F, Platz Batista da Silva N, Ludwig N, Meier JK, Ettl T, Reichert TE, Spoerl S. Two-Dimensional Post-Traumatic Measurements of Orbital Floor Blowout Fractures Underestimate Defect Sizes Compared to Three-Dimensional Approaches. Tomography 2023; 9:579-588. [PMID: 36961006 PMCID: PMC10037578 DOI: 10.3390/tomography9020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Orbital floor fractures represent a common fracture type of the midface and are standardly diagnosed clinically as well as radiologically using linear measurement methods. The aim of this study was to evaluate the accuracy of diagnostic measurements of isolated orbital floor fractures based on two-dimensional (2D) and three-dimensional (3D) measurement techniques. A cohort of 177 patients was retrospectively and multi-centrically evaluated after surgical treatment of an orbital floor fracture between 2010 and 2020. In addition to 2D and 3D measurements of the fracture area, further fracture-related parameters were investigated. Calculated fracture areas using the 2D measurement technique revealed an average area of 287.59 mm2, whereas the 3D measurement showed fracture areas with a significantly larger average value of 374.16 mm2 (p < 0.001). On average, the 3D measurements were 1.53-fold larger compared to the 2D measurements. This was observed in 145 patients, whereas only 32 patients showed smaller values in the 3D-based approach. However, the process duration of the 3D measurement took approximately twice as long as the 2D-based procedure. Nonetheless, 3D-based measurement of orbital floor defects provides a more accurate estimation of the fracture area than the 2D-based procedure and can be helpful in determining the indication and planning the surgical procedure.
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Affiliation(s)
- Juergen Taxis
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lena Ungerboeck
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Mika R Gehrking
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Constantin Motel
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Matthias Wurm
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Alexander W Eckert
- Department of Cranio- and Maxillofacial Surgery, Paracelsus Medical University Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany
| | - Gerrit Spanier
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Felix Nieberle
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | | | - Nils Ludwig
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Johannes K Meier
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Torsten E Reichert
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Steffen Spoerl
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Raveggi E, Gerbino G, Autorino U, Novaresio A, Ramieri G, Zavattero E. Accuracy of intraoperative navigation for orbital fracture repair: A retrospective morphometric analysis. J Craniomaxillofac Surg 2023; 51:107-116. [PMID: 36797080 DOI: 10.1016/j.jcms.2023.01.016] [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: 01/25/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
In this retrospective case series, patients undergoing surgery to treat isolated orbital floor fractures were morphometrically analyzed. Cloud Compare was used to compare mesh positioning with a virtual plan, using the distance-to-nearest-neighbor method. To assess the accuracy of mesh positioning, a mesh area percentage (MAP) parameter was introduced and three distance ranges were defined as the outcome measures: the 'high-accuracy range' included MAPs at a distance of 0-1 mm from the preoperative plan; the 'intermediate-accuracy range' included MAPs at a distance of 1.1-2 mm from the preoperative plan; the 'low-accuracy range' included MAPs at a distance of >2 mm from the preoperative plan. To complete the study, morphometric analysis of the results was combined with clinical judgment ('excellent', 'good', or 'poor') of mesh positioning by two independent blind observers. In total, 73 of 137 orbital fractures met the inclusion criteria. In the 'high-accuracy range' the mean, minimum, and maximum MAP values were 64%, 22%, and 90%, respectively. In the 'intermediate-accuracy range', the mean, minimum, and maximum values were 24%, 10%, and 42%, respectively. In the 'low-accuracy range', the values were 12%, 1%, and 48%, respectively. Both observers classified 24 cases of mesh positioning as 'excellent', 34 as 'good', and 12 as 'poor'. Within the limitations of the study, it seems that virtual surgical planning and intraoperative navigation has the potential to add quality to the repair of the orbital floor and, therefore, should be taken into consideration whenever appropriate.
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Affiliation(s)
- Elisa Raveggi
- Division of Maxillofacial Surgery, Surgical Science Department, Maxillofacial Unit, University of Torino, Italy
| | - Giovanni Gerbino
- Division of Maxillofacial Surgery, Surgical Science Department, Maxillofacial Unit, University of Torino, Italy
| | - Umberto Autorino
- Division of Maxillofacial Surgery, Surgical Science Department, Maxillofacial Unit, University of Torino, Italy
| | - Andrea Novaresio
- Department of Management and Production Engineering, Polytechnic University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Surgical Science Department, Maxillofacial Unit, University of Torino, Italy
| | - Emanuele Zavattero
- Division of Maxillofacial Surgery, Surgical Science Department, Maxillofacial Unit, University of Torino, Italy.
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Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? J Pers Med 2022; 12:jpm12091389. [PMID: 36143174 PMCID: PMC9500717 DOI: 10.3390/jpm12091389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair. With anatomically critical structures at risk during the surgical approach, surgeons’ view on the necessity of medial orbital wall repair often is restricted and an aesthetically disturbing enophthalmos is more likely to be accepted. Therefore, treatment options range from leaving the medial wall without repair to reconstruction with autogenous tissue or alloplastic materials, which can lead to moderate to severe side effects. However, emerging technologies such as patient-specific implants (PSI) offer a reliable and anatomically correct reconstruction of the bony orbit. This study aimed to evaluate the outcome of full orbital reconstruction using PSIs compared to only orbital floor repair using PDS (bioresorbable polydioxanone) foils leaving the medial orbital wall untouched in traumatic two-wall orbital fractures. Of all patients treated at the University Hospital of Düsseldorf between 2017 and 2019 who suffered from traumatic orbital fracture, only patients with a two-wall orbital fracture involving both the orbital floor and the medial wall (n = 68) were included. Patients were treated either with a PSI (n = 35) or a PDS foil (n = 33). Primary outcome parameters were ophthalmological disturbances analyzed via clinical investigation and intra-orbital angles, volumes and implant position analyzed with radiological 3D-datasets. While a two-wall reconstruction using PSIs led to a significant improvement of the enophthalmos, the rate of postoperative enophthalmos was significantly increased in cases of only orbital floor repair with PDS foils. Radiologically, a significant reconstruction of the three-dimensional bony orbit succeeded with the simple use of PSIs leading to a significant reduction in the traumatically enlarged orbital volume. PSI also led to a significant reduction in the traumatically enlarged medial angle of the orbit. This was not the case for single-floor repair with PDS foil. The results of this study suggest that complex orbital fractures can be reconstructed at an even higher degree of accuracy with selective laser-melted PSIs than PDS foils. In order to achieve a true to original reconstruction of the bony orbit, surgical treatment of the medial orbital wall can be advocated for in the long term depending on the indication.
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Bouet B, Schlund M, Sentucq C, Gryseleyn R, Ferri J, Nicot R. Radiographic volumetric risk factors for late enophthalmos prediction in orbital blow-out fractures: A retrospective study. J Craniomaxillofac Surg 2022; 50:478-484. [DOI: 10.1016/j.jcms.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/27/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
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