Is the Mirroring Technology Reliable in the Use of Computer-Aided Design for Orbital Reconstruction? Three-Dimensional Analysis of Asymmetry in the Orbits

Treatment of Mild-to-moderate Progressive Hemifacial Atrophy by Acellular Dermal Matrix Combined With Preoperative Digital Evaluation

Background

Progressive hemifacial atrophy (PHA) is a rare condition marked by the gradual degeneration of skin, soft tissues, muscles, and, in advanced stages, bone. The primary approach for managing PHA involves surgical interventions to reconstruct and restore the facial contour. The current treatments each present several limitations. Therefore, there is a critical need for innovative therapeutic methodologies for PHA soft-tissue reconstruction.

Methods

Eight patients diagnosed with Guerrerosantos II and III PHA were included in the study. Preoperative 3-dimensional facial scans were digitally analyzed, and corresponding 3-dimensional-printed models were generated to assess soft-tissue deficiencies. Based on this evaluation, acellular dermal matrix (ADM) was tailored to a stepped, multilayered composite dermis of a specific shape and size. It was then anatomically anchored at precise locations and supplemented with volume filler and ligament-mimicking repairs.

Results

The location, volume, and thickness of the ADM postoperatively were highly compatible with preoperative evaluations, significantly improving the facial contour and morphological and volumetric differences. All patients achieved good healing without other complications and reported improved postoperative scores on the FACE-Q craniofacial modules (P < 0.05).

Conclusions

Structural repair of PHA using ADM, guided by preoperative digital assessments, provides a safe, effective, and relatively stable outcome. This approach is innovative for achieving precise facial reconstruction.

Prediction of Permanent Enophthalmos Using 3-Dimensional Integral Model in Blowout Fractures

BACKGROUND

The objective of this study is to validate the possibility of setting volumetric surgical indications by predicting permanent enophthalmos using a simplified formula.

METHODS

The volume difference of bilateral orbits in a CT scan was automatically measured, and permanent enophthalmos was predicted by substituting the volume difference into a formula made using the 3-dimensional (3D) integral model.

RESULTS

The predicted enophthalmos showed a strong positive correlation with the permanent enophthalmos of 52 blowout fracture patients. Analyzing CT of 768 pure blowout fracture patients, the mean predicted enophthalmos was 1.84 mm, and both the size of the fracture area and the degree of EOM herniation showed the absence of correlations.

CONCLUSIONS

Through the digitized orbital volume analysis and formula using the 3D integral model, blowout fracture patients who require surgery in the early post-traumatic period can be identified with convenience and reproducibility.

Patient-specific implants in orbital reconstruction

PURPOSE OF REVIEW

Advances in the use of patient-specific implants (PSIs) and virtual surgical planning (VSP) for reconstruction of primary and secondary traumatic orbital defects are explored.

RECENT FINDINGS

PSIs and VSP are emerging technologies that promise to make complex orbital reconstructions safer and more predictable for patients. Recent studies highlight principles of implant design, the novel use of multiunit implant constructs, and utility of intraoperative imaging adjuncts to achieve favorable outcomes.

SUMMARY

This article summarizes recent developments in PSIs for orbital reconstruction. A complete workflow including presurgical planning, execution in the operating room, postoperative analysis, and avoidance of common pitfalls and implant design errors are reviewed.