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Jiang C, Lin Y, Jiang Y, Huang J, Wang R, Lin L, Huang L. Modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex fractures: A 5-year retrospective study. J Craniomaxillofac Surg 2024; 52:606-611. [PMID: 38448338 DOI: 10.1016/j.jcms.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/17/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024] Open
Abstract
Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures. The retrospective non-randomized study was conducted in a single hospital in China. All patients diagnosed with unilateral comminuted ZMC fractures between January 1, 2018 and December 31, 2022 were retrospectively reviewed. All patients underwent preoperative spiral computed tomography (CT). CT data were processed using software to DICOM format and transferred to Proplan CMF3.0 for preoperative virtual surgical planning and postoperative evaluation. All data were extracted from standardized electronic medical records. All statistical analyses were performed using SPSS version 20.0. The chi-square test and t-test were used for statistical analyses. The 54 included patients were divided into two comparable, equal cohorts of 27 patients, and followed up for at least 6 months. Fracture reduction was assisted using the modified patient-specific surgical guides in the guide group (23 males, four females; mean age 37.74 ± 12.07 years) and without the modified patient-specific surgical guides in the control group (20 males, seven females; mean age 37.44 ± 13.58 years). In the guide group, the mean eminence deviation between the affected and unaffected sides was 1.01 ± 0.92 mm, and the mean width deviation between the affected and unaffected sides was 1.29 ± 1.32 mm. In the control group, the mean eminence deviation between the affected and unaffected sides was 1.99 ± 1.69 mm, and the mean width deviation between the affected and unaffected sides was 2.68 ± 2.01 mm. The differences in facial protrusion (p = 0.001) and width (p = 0.003) symmetry between the affected and healthy sides of the two groups were statistically significant (p < 0.05). In conclusion, applying the modified patient-specific surgical guides to unilateral comminuted zygomaticomaxillary complex fracture reduction has the advantages of greater predictability and effectiveness, and improved bilateral ZMC symmetry. It should be noted that this approach would be especially beneficial for less-experienced surgeons.
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Affiliation(s)
- Canyang Jiang
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Department of Oral and Maxillofacial Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yuerong Lin
- Department of Anesthesiology, Anesthesiology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Yan Jiang
- Oral Medical Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Jianping Huang
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Department of Oral and Maxillofacial Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Rihui Wang
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Department of Oral and Maxillofacial Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Lisong Lin
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Department of Oral and Maxillofacial Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Li Huang
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China; Department of Oral and Maxillofacial Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
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Consorti G, Monarchi G, Catarzi L. Presurgical Virtual Planning and Intraoperative Navigation with 3D-Preformed Mesh: A New Protocol for Primary Orbital Fracture Reconstruction. Life (Basel) 2024; 14:482. [PMID: 38672753 PMCID: PMC11050995 DOI: 10.3390/life14040482] [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: 02/11/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. METHODS Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. RESULTS Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601-0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451-1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. CONCLUSION The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.
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Affiliation(s)
- Giuseppe Consorti
- Department of Maxillofacial Surgery, Azienda Ospedaliera Universitaria “Ospedali Riuniti di Ancona” Umberto I, 60126 Ancona, Italy;
| | - Gabriele Monarchi
- Department of Maxillofacial Surgery, Hospital of Perugia, Sant’Andrea delle Fratte, 06129 Perugia, Italy;
| | - Lisa Catarzi
- Department of Maxillofacial Surgery, University of Siena, 53100 Siena, Italy
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Consorti G, Betti E, Catarzi L. Customized orbital implant versus 3D preformed titanium mesh for orbital fracture repair: A retrospective comparative analysis of orbital reconstruction accuracy. J Craniomaxillofac Surg 2024; 52:532-537. [PMID: 38368208 DOI: 10.1016/j.jcms.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/29/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
This study aimed to compare the accuracy of inferomedial orbital fracture restoration using customized orbital implant versus 3D preformed titanium mesh. Patients were divided into two groups. Group 1 underwent surgery with customized orbital implants and intraoperative navigation, while group 2 was treated using 3D preformed titanium meshes with preoperative virtual surgical planning (VSP) and intraoperative navigation. Reconstruction accuracy was assessed by: (1) comparing the postoperative reconstruction mesh position with the preoperative VSP; and (2) measuring the difference between the reconstructed and unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were also evaluated. Fifty-two patients were enrolled (25 in group 1 vs 27 in group 2). The mean difference between final plate position and ideal digital plan was 0.62 mm (SD = 0.235) in group 1 and 0.69 mm (SD = 0.246) in group 2, with no statistical difference between the groups (p = 0.282). The mean volume differences between the reconstructed and unaffected orbits were 0.95 ml and 1.02 ml in group 1 and group 2, respectively, with no significant difference between the groups (p = 0.860). Overall clinical improvements, as well as complications, were similar. 3D preformed titanium meshes can reconstruct inferomedial fractures with the same accuracy as customized implants. Therefore, in clinical practice, it is recommended to use 3D preformed meshes for this type of fracture due to their excellent results and the potential for reducing time and costs.
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Affiliation(s)
- Giuseppe Consorti
- Department of Maxillofacial Surgery, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Umberto, Italy.
| | - Enrico Betti
- Department of Maxillofacial Surgery, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Umberto, Italy
| | - Lisa Catarzi
- Department of Maxillofacial Surgery, Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Umberto, Italy; Department of Maxillofacial Surgery, University of Siena, Siena, Italy
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