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Chodankar NU, Dhupar V, Akkara F, Vijay V. Matrixmidface Preformed Orbital Implants for Three-Dimensional Reconstruction of Orbital Floor and Medial Wall Fractures: A Prospective Clinical Study. Craniomaxillofac Trauma Reconstr 2024; 17:104-114. [PMID: 38779396 PMCID: PMC11107816 DOI: 10.1177/19433875231171749] [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: 05/25/2024] Open
Abstract
Study Design Prospective Interventional study. Objective To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures. Methods This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of orbital floor and medial wall fracture defects using Matrixmidface Preformed Orbital plates and open reduction and internal fixation of associated fractures. The following parameters were studied preoperative and postoperative enophthalmos, hypoglobus, orbital volume; correction of diplopia, intraoperative and postoperative complications. Results All 14 patients were males aged between 19 and 42 years. The most common mode of injury was found to be road traffic accidents (RTAs) followed by self-fall and trauma at workplace. Orbital fractures were associated with other concomitant maxillofacial fractures in 12 patients (85.7%) while 2 patients (14.3%) had pure blowout fractures. Significant improvement of enophthalmos was noted from preoperative period to 1 week, 6 weeks, and 6 months postoperatively (P value .02, .01, and .01, respectively). Out of 11 patients with preoperative hypoglobus, 5 patients (45.45%) had persistent hypoglobus in the immediate postoperative period which reduced to 4 patients (36.36%) at 6 weeks postoperatively (p value .00). The postoperative orbital volume of fractured side ranged from 20.3 cm3 to 26.76 cm3 with a mean of 23.50 cm3 ± 1.74. The mean difference between the volumes of the repaired and uninjured sides was found to be .27 cm3 ± .39 (P value .02) denoting that the reconstruction of the orbit closely approximated that of the uninjured side. Conclusions The Matrixmidface Preformed Orbital plate provides exceptional reconstruction of the orbital blowout fracture defects and ensures satisfactory results clinically and radiographically. The plate ensures an approximate recreation of topographical anatomy of the orbit and adequately restores the orbital volume. It provides adequate correction of asymmetry, hypoglobus, enophthalmos and attempts to restore eye movements, without causing any significant postoperative complication.
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Affiliation(s)
- Neha Umakant Chodankar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, India
| | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, India
| | - Francis Akkara
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, India
| | - Vathsalya Vijay
- Department of Ophthalmology, Goa Medical College and Hospital, Bambolim, India
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Comparison of Postoperative Enophthalmos Between Fresh and Delayed Unilateral Orbital Fractures After Orbital Reconstruction With Titanium Mesh Using Computer-Assisted Navigation. J Craniofac Surg 2023; 34:663-668. [PMID: 36166498 DOI: 10.1097/scs.0000000000009029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/20/2022] [Indexed: 11/26/2022] Open
Abstract
This study compares postoperative enophthalmos between fresh and delayed unilateral orbital fractures after orbital reconstruction with titanium mesh using computer-assisted navigation. The sample was composed of 45 patients with post-traumatic unilateral enophthalmos who were divided into the fresh fracture group and the delayed fracture group. They underwent orbital reconstruction with standard preformed orbital implants and computer-assisted navigation system. The following parameters were measured with computed tomography images: the degree of enophthalmos, orbital volume, and fracture defect area. Patients were reviewed preoperatively (T0), 1 week postoperatively (T1), and 6 months postoperatively (T2). Computed tomography measurements showed that in both groups, the degree of enophthalmos decreased after surgery but increased significantly from T1 to T2 ( P <0.05). ΔE (difference in the degree of enophthalmos between T1 and T2) was similar in patients with fresh and delayed fractures. There was a significant difference in the degree of ΔE between patients with single-wall orbital fractures and those with two-wall orbital fractures. The findings indicate that postoperative enophthalmos is common in both the groups and is closely related to the degree of preoperative enophthalmos. Furthermore, the recurrence of enophthalmos is similar between the 2 groups, but it is higher in patients with orbital fractures involving 2 walls.
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Zhang W, Cao X, Yang L, Duan Y, Zhang W. A clinical study of the effect of 3D reconstruction on exophthalmos after an operation on an old orbital wall fracture. Technol Health Care 2023; 31:1647-1657. [PMID: 36970917 DOI: 10.3233/thc-220245] [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] [Indexed: 06/18/2023]
Abstract
BACKGROUND Orbital blowout fracture is common in ocular trauma. Accurate measurement of orbital volume after fracture is key in improving intraocular correction. OBJECTIVE This study aims to explore the impact of 3D reconstruction technology in restoring normal exophthalmos in patients with old orbital wall fractures. METHODS A total of 31 patients were randomly divided into an experimental group (n= 15) and a control group (n= 16). For orbital wall repair and reconstruction, the conventional group used the conventional surgical scheme, and the 3D group used 3D printing technology. RESULTS There was no statistical difference between the preoperative mean extraocular muscle volume of the healthy eye and the affected eye. However, the mean orbital volume (24.76 vs 27.11, P= 0.005) and mean retrobulbar fat volume (17.53 vs 16.42, P= 0.006) were significantly different between the healthy eye and the affected eye. After an average follow-up of 16 weeks, the differences in pre- and post-surgery exophthalmos in the two groups were 0.42 ± 0.08 mm and 1.63 ± 0.51 mm, respectively. The difference between the two groups was statistically significant (t= 4.42, P= 0.003). The complications were not statistically different. CONCLUSION Using 3D reconstruction technology preoperatively can significantly improve exophthalmos in patients with old orbital wall fractures.
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Affiliation(s)
- Weiliang Zhang
- Department of Ophthalmology, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
- Department of Ophthalmology, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Xiaoqin Cao
- Department of General Surgery, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Ophthalmology, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Lu Yang
- Department of Ophthalmology, Changzhi Aier Eye Hospital, Changzhi, Shanxi, China
| | - Yajian Duan
- Department of Ophthalmology, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
| | - Wei Zhang
- Department of Ophthalmology, Shanxi Bethune Hospital, Taiyuan, Shanxi, China
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Park J, Jo S, Choi HY. Clinical Results According to Inferior Oblique Manipulation in Patients with Inferomedial Blowout Fracture Involving the Orbital Strut. Clin Ophthalmol 2022; 16:4263-4272. [PMID: 36578666 PMCID: PMC9791563 DOI: 10.2147/opth.s394722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Detachment of the inferior oblique muscle may be necessary under certain circumstances to repair a large inferomedial orbital fracture involving the orbital strut. This study aimed to evaluate the outcomes of patients who underwent surgeries with and without inferior oblique muscle reattachment after its detachment to repair the orbital wall fractures. Methods Forty patients who underwent repair of combined floor and medial orbital wall fracture involving the orbital strut at a single tertiary institution between January 2014 and December 2020 were reviewed. Groups 1 and 2 comprised 20 patients each, who underwent surgery with inferior oblique muscle detachment without and with reattachment, respectively, and were followed up for at least 6 months postoperatively. Enophthalmos, Goldmann diplopia test, alignment test, ocular motility test, and orbital inferomedial angle ratio were the outcome measures. Results Statistically significant improvement was observed in ocular motility, diplopia, and enophthalmos postoperatively at the 1- and 6-month follow-up (p < 0.01). The mean postoperative inferomedial angle ratio (102.28 ± 10.62%) was improved significantly compared with the preoperative inferomedial angle ratio (115.61 ± 4.38%) (p = 0.004) in all patients. After surgery, inferior oblique muscle underaction was observed in seven and six patients in groups 1 and 2, respectively, which was associated with preoperative extraocular movement limitation and strabismus. Two patients showed diplopia in both groups at the last follow-up; they had inferior oblique muscle underaction but no enophthalmos. Conclusion Orbital fracture repair with or without inferior oblique muscle reattachment was clinically effective and safe; however, patients with preoperative strabismus and extraocular motility limitation should be informed of the increased risk of postoperative complications.
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Affiliation(s)
- Jungyul Park
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, South Korea,Biomedical Research Institute, Pusan National University, Busan, South Korea
| | - Sunghyun Jo
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Hee-Young Choi
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, South Korea,Biomedical Research Institute, Pusan National University, Busan, South Korea,Correspondence: Hee-Young Choi, Department of Ophthalmology, School of Medicine, Biomedical Research Institute, Pusan National University, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, Republic of Korea, Tel +82-51-240-7324, Fax +82-51-242-7341, Email
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Canzi G, Corradi F, Novelli G, Bozzetti A, Sozzi D. "6 Anatomical Landmarks" Technique for Satisfactory Free-Hand Orbital Reconstruction With Standard Preformed Titanium Mesh. Craniomaxillofac Trauma Reconstr 2022; 15:51-57. [PMID: 35265278 PMCID: PMC8899354 DOI: 10.1177/19433875211007614] [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: 11/15/2022] Open
Abstract
Study Design Retrospective study. Objective Resolution of clinical signs and symptoms following orbital fractures depends on the accurate restoration of the orbital volume. Computer-Assisted procedures and Patient Specific Implants represent modern solutions, but they require additional resources. A more reproducible option is the use of standard preformed titanium meshes, widely available and cheaper; with their use quality of results is proportional to the accuracy with which they are positioned. This work identifies 6 reproducible and constant anatomical landmarks, as an intraoperative guide for the precise positioning of titanium preformed meshes. Methods 90 patients treated at the Maxillofacial Surgery Department, Niguarda Trauma Center, Milan, for unilateral orbital reconstruction (January 2012 to December 2018), were studied. In all cases reconstruction was performed respecting the 6 proposed anatomical landmarks. The outcomes analyzed are: post-operative CT adherence to the 6 anatomical markers and symmetry achieved respect to controlateral orbit; number/year of re-interventions and duration of surgery; resolution of clinical defects (at least 12-months follow-up); incidence of complications. Results Satisfactory results were obtained in terms of restoration of orbital size, shape and volume. Clinical defects early recovered with a low incidence of complications and re-interventions. Operating times and radiological accuracy have shown a progressive improvement during years of application of this technique. Conclusions The proposed "6 anatomical landmarks" is an easy free-hand technique that allows everyone to obtain high levels of reconstructive accuracy and it should be a skill of all surgeons who deal with orbital reconstruction in daily clinical activity.
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Affiliation(s)
- Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Milan, Italy,Gabriele Canzi, MD, Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Federica Corradi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Alberto Bozzetti
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Amin D, Jeong J, Manhan AJ, Bouloux GF, Abramowicz S. Do Racial Differences in Orbital Volume Influence the Reconstruction of Orbital Trauma. J Oral Maxillofac Surg 2022; 80:121-126. [PMID: 34973720 DOI: 10.1016/j.joms.2021.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Successful orbital reconstruction relies on an accurate restoration of orbital volume (OV). The purpose of this study was to determine if the OV of African American (AA) subjects differs from that of Caucasian subjects. METHODS The authors implemented a retrospective observational study of successive subjects who received a maxillofacial computed tomography (CT) scan at a level I trauma center between 2017 and 2020. The primary predictor variable was race (AA/Caucasian). The primary outcome variable was orbital volume. Two independent examiners calculated OV with an open access OsiriX MD software version 10.0.5 (Pixmeo, Switzerland). Inter-rater reliability was calculated. Differences between races, genders, and sides were tested using independent samples t test with a significance of P < .05. RESULTS Sixty subjects (120 orbits) were included in the study. The mean age was 36.7 (SD ± 13.2) years with a range of 22 to 78 years. Gender distribution was equal with 30 male (50%) and 30 female (50%) subjects. Inter-examiner reliability was 0.973. The mean OV of AA and Caucasians was 22.38 and 23.23 cm3, respectively (P = .07). The mean OV of AA and Caucasian males was 23.92, and 24.17cm3, respectively (P = .71). The mean OV in AA and Caucasian females was 20.84 and 22.28cm3, respectively (P = .013). CONCLUSIONS African-American female subjects appear to have a smaller OV when compared with Caucasians which may influence orbital reconstruction. Laterality does not appear to be associated with any differences in OV.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA.
| | - James Jeong
- Resident-in-training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Gary F Bouloux
- Professor in Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Soh HY, Sun Q, Hu LH, Wang Y, Mao C, Peng X, Zhang WB. Accuracy of globe-sparing orbital reconstruction using individually bent titanium mesh: A comparative study. J Plast Reconstr Aesthet Surg 2022; 75:1971-1978. [DOI: 10.1016/j.bjps.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/09/2021] [Accepted: 01/09/2022] [Indexed: 11/25/2022]
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Prebending of Prefabricated Orbital Implants: Towards Improved Orbital Angle Symmetry Post Craniofacial Trauma Surgery. J Craniofac Surg 2021; 33:740-743. [PMID: 34802018 DOI: 10.1097/scs.0000000000008107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Reconstructive surgery after craniofacial trauma aim to restore orbital anatomy for function and aesthetic reasons. The purpose of this study is to improve postoperative orbital symmetry with the use of prebent prefabricated titanium implants. METHODS In this retrospective study, patients with combined unilateral medial wall and floor fractures who underwent orbital reconstruction surgery were selected. The angle of inferomedial orbital strut (AIOS) was measured at 3 standard locations on preoperative facial computed tomography guided scans of the nonfractured orbit in the coronal view and used as a guide to bend the prefabricated titanium implants intraoperatively. The corresponding values were measured on the postoperative computed tomography and compared for symmetry. RESULTS Out of 83 patients recruited for the study, 54 were in the prebent group while 29 were in the control group. All other demographics were similar among the 2 groups. Anterior AIOS has a difference of 4.9° between 2 orbits in the prebent group whereas a difference of 15.5° was noted in the nonprebent group. For middle AIOS, a difference of 4.7° was noted in the prebent group whereas nonprebent group had a difference of 14.1°. For posterior AIOS, the prebent group had a difference of 3.8° versus 14.1° in the nonprebent group. The difference in AIOS at all 3 points between the prebent and nonprebent group were significant. CONCLUSIONS Anatomical prefabricated titanium plates are versatile implants that facilitate orbital reconstruction. Prebending of these implants according to the fellow orbit can achieve better surgical outcomes in a cost-effective manner.
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Probst FA, Cornelius CP, Otto S, Malenova Y, Probst M, Liokatis P, Haidari S. Accuracy of free-hand positioned patient specific implants (PSI) in primary reconstruction after inferior and/or medial orbital wall fractures. Comput Biol Med 2021; 137:104791. [PMID: 34464850 DOI: 10.1016/j.compbiomed.2021.104791] [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: 05/02/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To assess the accuracy with which CAD/CAM-fabricated patient-specific titanium implants (PSI) are positioned for inferior and/or medial orbital wall reconstruction without the use of intraoperative navigation. METHODS Patients who underwent a primary reconstruction of the orbital walls with PSI due to fractures were enrolled in this retrospective cohort analysis. The primary outcome variables were the mean surface distances (MSD) between virtually planned and postoperative PSI position and single linear deviations in the x-, y- and z-axis at corresponding reference points. Secondary outcome variables included demographic data, classification of orbital wall defects and clinical outcomes. RESULTS A total of 33 PSI (orbital floor n = 22; medial wall, n = 11) were examined in 27 patients. MSD was on a comparable level for the orbital floor and medial wall (median 0.39 mm, range 0.22-1.53 mm vs. median 0.42 mm, range 0.21-0.98 mm; p = 0.56). Single linear deviations were lower for reconstructions of the orbital floor compared to the medial wall (median 0.45 vs. 0.79 mm; p < 0.05). There was no association between the occurrence of diplopia and the accuracy level (p = 0.418). CONCLUSIONS Free-hand positioning of PSI reaches a clinically appropriate level of accuracy, limiting the necessity of navigational systems to selected cases.
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Affiliation(s)
- Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU, München, Germany.
| | - Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU, München, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU, München, Germany
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU, München, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, München, Germany
| | - Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU, München, Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU, München, Germany
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Going beyond the limitations of the non-patient-specific implant in titanium reconstruction of the orbit. Br J Oral Maxillofac Surg 2021; 59:1074-1078. [PMID: 34284883 DOI: 10.1016/j.bjoms.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
Reconstruction of post traumatic orbital defects has undergone a stepwise evolution following developments in reconstructive materials and surgical techniques. Advances in communication between surgical teams and design technicians have allowed provision of bespoke surgical plates with a high degree of accuracy and surgical relevance in an appropriate timeframe. We present a case series of 41 consecutive patients treated in London and BernBern Switzer between March 2019 and September 2020 with extensive defects reconstructed with patient specific orbital plates. Complexity of fracture was risk adjusted using the Jaquiery scale with one patient (J3), 14 patients (J4), and 26 Patients (J5). Outcome was assessed by accuracy of fit at the surgical margins and was 94.5%. The study group was statistically tested against a previous series by the same group and was statistically different with respect to the case complexity (p<0.001) and accuracy of fit (p<0.001) (Fisher's exact test). Complications included the removal on one plate due to patient choice, with perfect surgical position and resolving diplopia. Only one plate articulation was poor, this mitigated by the size of the defect and the orbital soft tissue swelling which prohibited seating the implant. The patient remains well with acceptable function and satisfactory aesthetics. We present design considerations including the use two part plates, and surgical pearls to achieve predictable placement. We believe that the use of custom plates for reconstruction of Jaquiery 4 and 5 should be considered. We regard this technology as a game changer in surgical management of the complex high risk orbit.
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Nikunen M, Rajantie H, Marttila E, Snäll J. Implant malposition and revision surgery in primary orbital fracture reconstructions. J Craniomaxillofac Surg 2021; 49:837-844. [PMID: 33985870 DOI: 10.1016/j.jcms.2021.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/19/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to assess factors leading to revision surgery and implant position of primary orbital fracture reconstructions. A retrospective cohort included patients who underwent orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type, surgery and implant-related variables, and postoperative implant position were analyzed. The overall revision surgery rate was 6.5% (15 of 232 surgeries). The rate was highest in combined midfacial fractures with rim involvement (14.0%), lower in zygomatico-orbital fractures (8.7%), and lowest in isolated blowout fractures (3.8%). Fracture type, orbital rim fixation and implant malposition predicted revision. The best positioning was achieved with patient-specific milled titanium implants (mtPSI) and resorbable materials, whereas the poorest with preformed three-dimensional titanium plates. Combined midfacial fractures with rim involvement in particular have a high risk for orbital revision surgery. Within the limitations of the present study, mtPSIs should be preferred in the reconstruction of primary orbital fractures if possible.
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Affiliation(s)
- Matti Nikunen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Hanna Rajantie
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Emilia Marttila
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Low-Cost, Three-Dimensionally-Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction. Plast Reconstr Surg 2021; 147:162-166. [PMID: 33370061 DOI: 10.1097/prs.0000000000007495] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking complications. Three-dimensional printing technology has enabled health care facilities to generate custom anatomical models to which implants can be molded to precisely match orbital anatomy. The authors present their early experience with these models and their use in optimizing orbital fracture fixation. METHODS Maxillofacial computed tomographic scans from patients with orbital floor or wall fractures were prospectively obtained and digitally reconstructed. Both injured-side and mirrored unaffected-side models were produced in-house by stereolithography printing technique. Models were used as templates for molding titanium reconstruction plates, and plates were implanted to reconstruct the patients' orbital walls. RESULTS Nine patients (mean age, 15.5 years) were included. Enophthalmos was present in seven patients preoperatively and resolved in six patients with surgery. All patients had excellent conformation of the implant to the fracture site on postoperative computed tomographic scan. Postoperative fracture-side orbital volumes were significantly less than preoperative, and not significantly different from unfractured-side orbital volumes. Total model preparation time was approximately 10 hours. Materials cost was at most $21. Plate bending time was approximately 60 seconds. CONCLUSIONS Patient-specific orbital models can speed the shaping of orbital reconstruction implants and potentially improve surgical correction of orbital fractures. Production of these models with consumer-grade technology confers the same advantages as commercial production at a fraction of the cost and time. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Utilizing 3D-Printed Orbital Floor Stamps to Create Patient-Specific Implants for Orbital Floor Reconstruction. Ophthalmic Plast Reconstr Surg 2021; 37:81-85. [PMID: 32433352 DOI: 10.1097/iop.0000000000001734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study seeks to test a novel technique of custom-printed midface contour models with orbital floor "stamps" to guide reconstruction of orbital floor blowout fractures, with or without concomitant zygomaticomaxillary complex injury. METHODS A series of 4 consecutive patients with orbital floor blowout fractures (including 3 with zygomatic maxillary complex fractures) were retrospectively examined for outcomes associated with orbital floor reconstruction using 3-dimensional-printed stamps and midface models. Data collected included demographics, pre- and postoperative visual globe malposition, motility, and visual field disturbances. Three-dimensional printing methodology is reported, as well as associated costs and time required to generate the models and stamps. RESULTS The cost of producing a midface-contour model and orbital floor stamps was $131, inclusive of labor and materials. Cases averaged 170 minutes to segment, design, and print. Patients with preoperative diplopia and motility restrictions had resolution of their symptoms. Two patients had resolution of their enophthalmos, while one patient with a concomitant zygomaticomaxillary fracture had persistent mild enophthalmos. CONCLUSIONS Midface contour models and orbital floor stamps may be produced in a timely and cost-effective manner. Use of these "homemade" stamps allows for patient-specific custom-contoured orbital floor reconstruction. Further studies are warranted to examine long-term visual and esthetic outcomes for these patients.
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Holmes S. Primary Orbital Fracture Repair. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:51-77. [PMID: 33516540 DOI: 10.1016/j.cxom.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Simon Holmes
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London, UK.
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Wang W, Namin A, Shokri T, Ducic Y. Customized Orbit and Frontal Bone Implants. Facial Plast Surg 2020; 36:711-714. [PMID: 33368126 DOI: 10.1055/s-0040-1721109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Orbitocranial reconstruction objectives include creation of a solid barrier between intracranial contents and the environment allowing restoration of physiologic homeostasis and restoration of aesthetic craniofacial contours. Historically, bone grafts have been used for reconstruction but were fraught with unpredictable resorption and imperfect contouring given the complex anatomy of the orbitofrontal bones. With advances in three-dimensional modeling technology, alloplastic custom implants in orbital and frontal bone reconstruction have allowed for rapid fixation reducing surgical times and improved cosmesis.
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Affiliation(s)
- Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Arya Namin
- Department of Otolaryngology Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Esmail MEK, Ibrahiem MFK, Abdallah RMA, Elshafei AMK, Gawdat TI. Resorbable polylactic acid polymer plates in repair of blow-out orbital floor fractures. Eur J Ophthalmol 2020; 31:1384-1390. [PMID: 32476460 DOI: 10.1177/1120672120928005] [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: 11/16/2022]
Abstract
PURPOSE To evaluate the use of the resorbable polylactic acid polymer implants (Resorb X) in the management of orbital floor blow-out fractures as regards safety, cosmetic, and functional results. METHODS In a prospective, interventional case series, 22 patients with traumatic blow-out floor fractures underwent lower fornix transconjunctival repair using polylactic acid implant insertion over the defect without fixation. Orbital imaging was done preoperatively, at 1 month and 1 year postoperatively with orbital computed tomography with 2 mm cuts of axial, sagittal, and coronal scans. Outcome measures included the maximum vertical height of the orbit at the fracture plane and its changes over time. RESULTS At the final follow-up, both limitation of elevation and diplopia improved in 82% of cases, while 63.6% of cases showed improvement of enophthalmos. Radiological restoration of the orbital vertical height was recorded in 100% of cases without implant displacement at 1 month. However, after 1 year, a significant floor bowing was found in 45.5% of cases, which showed a strong positive correlation with preoperative defect size (r = 0.820). CONCLUSIONS Resorb X mesh plates can be a good option for the safe reconstruction of orbital floor blow-out fractures. Good anatomical and functional results were obtained in small orbital floor defects. Late bowing under pressure may limit their use in medium-sized floor defects.
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Affiliation(s)
| | | | | | | | - Tamer Ismail Gawdat
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Hierl T, Kruber D, Doerfler HM, Huempfner-Hierl H, Krause M. Computer-Aided Versus Conventional Planning in Orbital Traumatology Using Preformed Meshes: Development of a New Workflow. J Oral Maxillofac Surg 2019; 77:1663-1672. [DOI: 10.1016/j.joms.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Orbital Fracture Reconstruction Using Prebent, Anatomic Titanium Plates: Technical Tips to Avoid Complications. J Craniofac Surg 2018; 29:e515-e517. [PMID: 29608480 DOI: 10.1097/scs.0000000000004563] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Orbital fractures are common. In patients where there is significant loss of the medial wall and orbital floor, anatomic prebent 3-dimensional plates allow efficacious restoration of orbital volume. However, the large size of these plates can result in technical difficulties with plate placement, especially in fractures with complete loss of 2 walls of the orbit. In this article, the authors review the pertinent anatomy of the bony orbit with respect to fracture and landmarks in fracture reduction. The authors also note the 3 most commonly encountered problems with the placement of anatomic plates: poor exposure, failure to identify the posterior ledge for the plate, and rotational issues with plate placement resulting in impingement. Technical tips are given to help overcome these issues intraoperatively.
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Generation of customized orbital implant templates using 3-dimensional printing for orbital wall reconstruction. Eye (Lond) 2018; 32:1864-1870. [PMID: 30154573 DOI: 10.1038/s41433-018-0193-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/19/2018] [Accepted: 07/11/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe and evaluate a novel surgical approach to orbital wall reconstruction that uses three-dimensionally (3D) printed templates to mold a customized orbital implant. METHODS A review was conducted of 11 consecutive patients who underwent orbital wall reconstruction using 3D-printed customized orbital implant templates. In these procedures, the orbital implant was 3D pressed during surgery and inserted into the fracture site. The outcomes of this approach were analyzed quantitatively by measuring the orbital tissue volumes within the bony orbit using computed tomography. RESULTS All 11 orbital wall reconstructions (6 orbital floor and 5 medial wall fractures) were successful with no post operative ophthalmic complications. Statistically significant differences were found between the preoperative and post operative orbital tissue volumes for the affected orbit (24.00 ± 1.74 vs 22.31 ± 1.90 cm3; P = 0.003). There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction (22.01 ± 1.60 cm3 vs 22.31 ± 1.90 cm3; P = 0.182). CONCLUSION 3D-printed customized orbital implant templates can be used to press and trim conventional implantable materials with patient-specific contours and sizes for optimal orbital wall reconstruction. It is difficult to design an orbital implant that exactly matches the shape and surface of a blowout fracture site due to the unique 3D structure of the orbit. The traditional surgical method is to visually inspect the fracture site and use eye measurements to cut a two-dimensional orbital implant that corresponds to the anatomical structure of the fracture site. However, implants that do not fit the anatomical structure of a fracture site well can cause complications such as enophthalmos, diplopia and displacement of the implant.
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Assessing the precision of posttraumatic orbital reconstruction through “mirror” orbital superimposition: A novel approach for testing the anatomical accuracy. J Craniomaxillofac Surg 2018; 46:1258-1262. [DOI: 10.1016/j.jcms.2018.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 11/18/2022] Open
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Stathopoulos P, Ameerally P. Reconstructing a Traumatic Empty Orbit: Principles, Difficulties of Treatment, and Literature Review. J Oral Maxillofac Surg 2018; 76:1952.e1-1952.e4. [PMID: 29775558 DOI: 10.1016/j.joms.2018.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This report describes the case of a serious orbital injury in which the globe was completely displaced into the nasal cavity and the orbit was clinically empty. The authors discuss the difficulties encountered in the management of this patient and their principles in the reconstruction of a complex defect. MATERIALS AND METHODS In this rare case of severe injury, the authors used a combined transconjunctival and ethmoidal approach to retrieve the displaced globe from the nasal cavity. This approach allowed ample access to the floor and the medial wall of the orbit; therefore, a single 0.5-mm titanium mesh was bent to fit the combined defect for reconstruction. RESULTS Early combined maxillofacial and oculoplastic surgical intervention resulted in salvage and restoration of the eye with preservation of vision. CONCLUSIONS Stable reconstruction of the maxillo-ethmoidal buttress is of great importance in patients with comminuted injuries. This strut determines the appropriate orbital volume and defines the position of the eye in space. Patients with insufficient restoration of the buttress are always at risk of developing enophthalmos. To replicate the contour of the S-shape of the orbital floor and the slope of the medial wall, the authors support the use of thin implants with rigid fixation on the bony orbit as the most suitable materials to achieve this. Thick implants can be rather difficult to bend, and when this is attempted several times they are more prone to fractures. Conversely, very thin and flexible implants can always be dislodged and cause late enophthalmos.
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Affiliation(s)
- Panagiotis Stathopoulos
- Associate Professor, Dublin Dental University Hospital; Consultant Oral and Maxillofacial Surgeon, Mater Hospital, Dublin, Ireland.
| | - Philip Ameerally
- Consultant Oral and Maxillofacial Surgeon, Northampton General Hospital, Northampton, UK
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Severe distortion of an orbital titanium mesh implant after recurrent facial trauma: a potential threat to the orbital contents? Br J Oral Maxillofac Surg 2017; 55:836-838. [DOI: 10.1016/j.bjoms.2017.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/22/2017] [Indexed: 11/24/2022]
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Low-Cost 3D Printing Orbital Implant Templates in Secondary Orbital Reconstructions. Ophthalmic Plast Reconstr Surg 2017; 33:376-380. [PMID: 28230707 DOI: 10.1097/iop.0000000000000884] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Despite its increasing use in craniofacial reconstructions, three-dimensional (3D) printing of customized orbital implants has not been widely adopted. Limitations include the cost of 3D printers able to print in a biocompatible material suitable for implantation in the orbit and the breadth of available implant materials. The authors report the technique of low-cost 3D printing of orbital implant templates used in complex, often secondary, orbital reconstructions. METHODS A retrospective case series of 5 orbital reconstructions utilizing a technique of 3D printed orbital implant templates is presented. Each patient's Digital Imaging and Communications in Medicine data were uploaded and processed to create 3D renderings upon which a customized implant was designed and sent electronically to printers open for student use at our affiliated institutions. The mock implants were sterilized and used intraoperatively as a stencil and mold. The final implant material was chosen by the surgeons based on the requirements of the case. RESULTS Five orbital reconstructions were performed with this technique: 3 tumor reconstructions and 2 orbital fractures. Four of the 5 cases were secondary reconstructions. Molded Medpor Titan (Stryker, Kalamazoo, MI) implants were used in 4 cases and titanium mesh in 1 case. The stenciled and molded implants were adjusted no more than 2 times before anchored in place (mean 1). No case underwent further revision. CONCLUSIONS The technique and cases presented demonstrate 1) the feasibility and accessibility of low-cost, independent use of 3D printing technology to fashion patient-specific implants in orbital reconstructions, 2) the ability to apply this technology to the surgeon's preference of any routinely implantable material, and 3) the utility of this technique in complex, secondary reconstructions.
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Doerfler HM, Huempfner-Hierl H, Kruber D, Schulze P, Hierl T. Template-Based Orbital Wall Fracture Treatment Using Statistical Shape Analysis. J Oral Maxillofac Surg 2017; 75:1475.e1-1475.e8. [DOI: 10.1016/j.joms.2017.03.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
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Virtual Fitting, Selection, and Cutting of Preformed Anatomic Orbital Implants. Ophthalmic Plast Reconstr Surg 2017; 33:196-201. [DOI: 10.1097/iop.0000000000000700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mottini M, Wolf CA, Seyed Jafari SM, Katsoulis K, Schaller B. Stereographic measurement of orbital volume, a digital reproducible evaluation method. Br J Ophthalmol 2017; 101:1431-1435. [DOI: 10.1136/bjophthalmol-2016-309998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/20/2017] [Accepted: 04/04/2014] [Indexed: 11/04/2022]
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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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Zimmerer RM, Ellis E, Aniceto GS, Schramm A, Wagner ME, Grant MP, Cornelius CP, Strong EB, Rana M, Chye LT, Calle AR, Wilde F, Perez D, Tavassol F, Bittermann G, Mahoney NR, Alamillos MR, Bašić J, Dittmann J, Rasse M, Gellrich NC. A prospective multicenter study to compare the precision of posttraumatic internal orbital reconstruction with standard preformed and individualized orbital implants. J Craniomaxillofac Surg 2016; 44:1485-97. [DOI: 10.1016/j.jcms.2016.07.014] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022] Open
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Application of Computer-Aided Designing and Rapid Prototyping Technologies in Reconstruction of Blowout Fractures of the Orbital Floor. J Craniofac Surg 2016; 26:1558-63. [PMID: 26125649 DOI: 10.1097/scs.0000000000001883] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Traumatology of the maxillofacial region represents a wide range of different types of facial skeletal injuries and encompasses numerous treatment methods. Application of computer-aided design (CAD) in combination with rapid prototyping (RP) technologies and three-dimensional computed tomography techniques facilitates surgical therapy planning for efficient treatment. OBJECTIVE The purpose of this study is to determine the efficiency of individually designed implants of poly-DL-lactide (PDLLA) in the reconstruction of blowout fractures of the orbital floor. METHODS In the course of a surgical treatment, individually designed implants manufactured by CAD/RP technologies were used. Preoperative analysis and postoperative monitoring were conducted to evaluate the successfulness of orbital floor reconstruction using customized PDLLA implants, based on: presence of diplopia, paresthesia of infraorbital nerve, and presence of enophthalmos. RESULTS In 6 of the 10 patients, diplopia completely disappeared immediately after surgical procedure. Diplopia gradually disappeared after 1 month in 3 patients, whereas in 1, it remained even after 6 months. In 7 patients, paresthesia disappeared within a month after surgery and in 3 patients within 2 months. Postoperative average Orbital volume (OV) of the injured side (13.333 ± 3.177) was significantly reduced in comparison with preoperative OV (15.847 ± 3.361) after reconstruction of the orbital floor with customized PDLLA implant (P < 0.001). Thus, average OV of corrected orbit was not different compared with the OV of the uninjured orbit (P = 0.981). CONCLUSIONS Reconstruction of blowout fractures of the orbital floor by an individually designed PDLLA implant combined with virtual preoperative modeling allows easier preoperative preparation and yields satisfactory functional and esthetic outcomes.
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Schiff BA, McMullen CP, Farinhas J, Jackman AH, Hagiwara M, McKellop J, Lui YW. Use of computed tomography to assess volume change after endoscopic orbital decompression for Graves' ophthalmopathy. Am J Otolaryngol 2015; 36:729-35. [PMID: 26545461 DOI: 10.1016/j.amjoto.2015.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/21/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orbital decompression is frequently performed in the management of patients with sight-threatening and disfiguring Graves' ophthalmopathy. The quantitative measurements of the change in orbital volume after orbital decompression procedures are not definitively known. Furthermore, the quantitative effect of septal deviation on volume change has not been previously analyzed. OBJECTIVES To provide quantitative measurement of orbital volume change after medial and inferior endoscopic decompression and describe a straightforward method of measuring this change using open-source technologies. A secondary objective was to assess the effect of septal deviation on orbital volume change. METHODS A retrospective review was performed on all patients undergoing medial and inferior endoscopic orbital decompression for Graves' ophthalmopathy at a tertiary care academic medical center. Pre-operative and post-operative orbital volumes were calculated from computed tomography (CT) data using a semi-automated segmenting technique and Osirix™, an open-source DICOM reader. Data were collected for pre-operative and post-operative orbital volumes, degree of septal deviation, time to follow-up scan, and individual patient Hertel scores. RESULTS Nine patients (12 orbits) were imaged before and after decompression. Mean pre-operative orbital volume was 26.99 cm(3) (SD=2.86 cm(3)). Mean post-operative volume was 33.07 cm(3) (SD=3.96 cm(3)). The mean change in volume was 6.08 cm(3) (SD=2.31 cm(3)). The mean change in Hertel score was 4.83 (SD=0.75). Regression analysis of change in volume versus follow-up time to imaging indicates that follow-up time to imaging has little effect on change in volume (R=-0.2), and overall mean maximal septal deviation toward the operative side was -0.5mm. Negative values were attributed to deviation away form the operative site. A significant correlation was demonstrated between change in orbital volume and septal deviation distance site (R=0.66), as well as between change in orbital volume and septal deviation angle (R=0.67). Greater volume changes were associated with greater degree of septal deviation away from the surgical site, whereas smaller volume changes were associated with greater degree of septal deviation toward the surgical site. CONCLUSION A straightforward, semi-automated segmenting technique for measuring change in volume following endoscopic orbital decompression is described. This method proved useful in determining that a mean increase of approximately 6 cm in volume was achieved in this group of patients undergoing medial and inferior orbital decompression. Septal deviation appears to have an effect on the surgical outcome and should be considered during operative planning.
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Affiliation(s)
- Bradley A Schiff
- Department of Otorhinolaryngology-Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave., Medical Arts Pavilion, 3rd Floor, Bronx, NY, United States
| | - Caitlin P McMullen
- Department of Otorhinolaryngology-Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave., Medical Arts Pavilion, 3rd Floor, Bronx, NY, United States.
| | - Joaquim Farinhas
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY, United States
| | - Alexis H Jackman
- Department of Otorhinolaryngology-Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Ave., Medical Arts Pavilion, 3rd Floor, Bronx, NY, United States
| | - Mari Hagiwara
- Department of Radiology, NYU School of Medicine, 660 First Avenue 2nd Floor, New York, NY, United States
| | - Jason McKellop
- Department of Radiology, NYU School of Medicine, 660 First Avenue 2nd Floor, New York, NY, United States
| | - Yvonne W Lui
- Department of Radiology, NYU School of Medicine, 660 First Avenue 2nd Floor, New York, NY, United States
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Susarla SM, Duncan K, Mahoney NR, Merbs SL, Grant MP. Virtual Surgical Planning for Orbital Reconstruction. Middle East Afr J Ophthalmol 2015; 22:442-6. [PMID: 26692714 PMCID: PMC4660529 DOI: 10.4103/0974-9233.164626] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The advent of computer-assisted technology has revolutionized planning for complex craniofacial operations, including orbital reconstruction. Orbital reconstruction is ideally suited for virtual planning, as it allows the surgeon to assess the bony anatomy and critical neurovascular structures within the orbit, and plan osteotomies, fracture reductions, and orbital implant placement with efficiency and predictability. In this article, we review the use of virtual surgical planning for orbital decompression, posttraumatic midface reconstruction, reconstruction of a two-wall orbital defect, and reconstruction of a large orbital floor defect with a custom implant. The surgeon managing orbital pathology and posttraumatic orbital deformities can benefit immensely from utilizing virtual planning for various types of orbital pathology.
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Affiliation(s)
- Srinivas M. Susarla
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Katherine Duncan
- Department of Ophthalmology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Nicholas R. Mahoney
- Department of Ophthalmology, Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shannath L. Merbs
- Department of Ophthalmology, Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael P. Grant
- Department of Plastic and Reconstructive Surgery and Department of Ophthalmology, Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
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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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Abstract
BACKGROUND Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. METHODS We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant. RESULTS In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed. CONCLUSIONS We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.
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Huempfner-Hierl H, Doerfler HM, Kruber D, Hierl T. Morphologic Comparison of Preformed Orbital Meshes. J Oral Maxillofac Surg 2015; 73:1119-23. [DOI: 10.1016/j.joms.2015.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/26/2015] [Indexed: 11/28/2022]
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Dubois L, Steenen SA, Gooris PJJ, Mourits MP, Becking AG. Controversies in orbital reconstruction--I. Defect-driven orbital reconstruction: a systematic review. Int J Oral Maxillofac Surg 2014; 44:308-15. [PMID: 25543903 DOI: 10.1016/j.ijom.2014.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
In the 1980s, computed tomography was introduced as an imaging modality for diagnosing orbital fractures. Since then, new light has been shed on the field of orbital fracture management. Currently, most surgeons are likely to repair orbital fractures based on clinical findings and particularly on data obtained from computed tomography scans. However, an important but unresolved issue is the fracture size, which dictates the extent and type of reconstruction. In other fields of trauma surgery, an increasing body of evidence is stressing the importance of complexity-based treatment models. The aim of this study was to systematically review all articles on orbital reconstruction, with a focus on the indication for surgery and the defect size and location, in order to identify the reconstruction methods that show the best results for the different types of orbital fractures.
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Affiliation(s)
- L Dubois
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
| | - S A Steenen
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - P J J Gooris
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Mourits
- Department of Ophthalmology, Orbital Unit, Academic Medical Centre of Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam, Academic Centre for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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Virtual surgery simulation in orbital wall reconstruction: Integration of surgical navigation and stereolithographic models. J Craniomaxillofac Surg 2014; 42:2025-34. [DOI: 10.1016/j.jcms.2014.09.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/19/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022] Open
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Three-dimensional pre-bent titanium implant for concomitant orbital floor and medial wall fractures in an East asian population. Arch Plast Surg 2014; 41:480-5. [PMID: 25276638 PMCID: PMC4179350 DOI: 10.5999/aps.2014.41.5.480] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/03/2013] [Accepted: 12/18/2013] [Indexed: 11/25/2022] Open
Abstract
Background The objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population. Methods Clinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect. Results Follow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment. Conclusions Three-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.
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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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Quantitative Assessment of Medial Orbit Fracture Repair Using Computer-Designed Anatomical Plates. Plast Reconstr Surg 2012; 130:698e-705e. [DOI: 10.1097/prs.0b013e3182686358] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Palmieri CF, Ghali G. Late Correction of Orbital Deformities. Oral Maxillofac Surg Clin North Am 2012; 24:649-63. [DOI: 10.1016/j.coms.2012.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Radiologic and Facial Morphologic Long-Term Results in Treatment of Orbital Floor Fracture With Flexible Absorbable Alloplastic Material. J Oral Maxillofac Surg 2012; 70:2375-85. [DOI: 10.1016/j.joms.2012.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 05/19/2012] [Accepted: 05/21/2012] [Indexed: 11/21/2022]
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Lieger O, Schaller B, Kellner F, Messmer-Schai B, Iizuka T. Low-profile titanium mesh in the use of orbital reconstruction: A pilot study. Laryngoscope 2012; 122:982-91. [DOI: 10.1002/lary.23200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/07/2011] [Accepted: 12/21/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Olivier Lieger
- Department of Cranio-Maxillofacial Surgery, Hospital Luzern, Luzern, Switzerland.
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Markiewicz MR, Dierks EJ, Potter BE, Bell RB. Reliability of Intraoperative Navigation in Restoring Normal Orbital Dimensions. J Oral Maxillofac Surg 2011; 69:2833-40. [DOI: 10.1016/j.joms.2010.12.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/21/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
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Reconstruction of Severe Medial Orbital Wall Fractures Using Titanium Mesh Plates Placed Using Transcaruncular-Transconjunctival Approach: A Successful Combination of 2 Techniques. J Oral Maxillofac Surg 2011; 69:1415-20. [DOI: 10.1016/j.joms.2010.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 06/02/2010] [Accepted: 07/03/2010] [Indexed: 11/24/2022]
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Long-term follow-up of blowout fractures of the orbital floor reconstructed with a polyglactin 910/PDS implant. Eur J Trauma Emerg Surg 2011; 37:609-13. [DOI: 10.1007/s00068-011-0081-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW Orbital trauma is common and frequently complicated by ocular injuries. The recent literature on orbital fracture is analyzed with emphasis on epidemiological data assessment, surgical timing, method of approach and reconstruction materials. RECENT FINDINGS Computed tomographic (CT) scan has become a routine evaluation tool for orbital trauma, and mobile CT can be applied intraoperatively if necessary. Concomitant serious ocular injury should be carefully evaluated preoperatively. Patients presenting with nonresolving oculocardiac reflex, 'white-eyed' blowout fracture, or diplopia with a positive forced duction test and CT evidence of orbital tissue entrapment require early surgical repair. Otherwise, enophthalmos can be corrected by late surgery with a similar outcome to early surgery. The use of an endoscope-assisted approach for orbital reconstruction continues to grow, offering an alternative method. Advances in alloplastic materials have improved surgical outcome and shortened operating time. SUMMARY In this review of modern orbital reconstruction, several controversial issues such as surgical indication, surgical timing, method of approach and choice of reconstruction material are discussed. Preoperative fine-cut CT image and thorough ophthalmologic examination are key elements to determine surgical indications. The choice of surgical approach and reconstruction materials much depends on the surgeon's experience and the reconstruction area. Prefabricated alloplastic implants together with image software and stereolithographic models are significant advances that help to more accurately reconstruct the traumatized orbit. The recent evolution of orbit reconstruction improves functional and aesthetic results and minimizes surgical complications.
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