A Case Series of Rapid Prototyping and Intraoperative Imaging in Orbital Reconstruction (original) (raw)
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Rapid prototyping technology in orbital floor reconstruction: application in three patients
Craniomaxillofacial trauma & reconstruction, 2014
Rapid prototyping entails the fabrication of three-dimensional anatomical models which provide an accurate and cost-effective method to visualize complex anatomical structures. Our unit has been using this to assist in the diagnosis, planning, and preoperative titanium plate adaptation for orbital reconstruction surgery following traumatic injury. The aim of this article is to demonstrate the potential clinical and cost-saving benefits of this technology.
Orbital Reconstruction: Prefabricated Implants, Data Transfer, and Revision Surgery
Facial Plastic Surgery, 2014
In craniomaxillofacial trauma orbital structures are involved in up to 40% of the cases due to its exposed position and its limited bone thickness. 1 External impact to this area may cause blowout fractures or zygomatic fractures involving the area of the orbital floor and/or the medial orbital wall. 2-4 An enlarged orbital volume may result in diplopia and enophthalmos, especially when the deep orbital cone is affected. 4,5 To prevent such complications precise reconstruction of the anatomical orbital structures is essential. 6
Craniomaxillofacial Trauma & Reconstruction, 2021
Post-traumatic reconstruction of the orbit can pose a challenge due to inherent intraoperative problems. Intra-orbital adipose tissue is difficult to manipulate and retract making visualization of the posterior orbital contents difficult. Rapid prototyping (RP) is a cost-effective method of anatomical model production allowing the surgeon to produce a patient specific implant (PSI) which can be pre-surgically adapted to the orbital defect with exact reconstruction. Intraoperative imaging allows immediate assessment of reconstruction at the time of surgery. Utilization and combination of both technologies improves accuracy of reconstruction with orbital implants and reduces cost, surgical time, and the rate of revision surgery.
Journal of Plastic Reconstructive and Aesthetic Surgery, 2021
Background: Secondary post-traumatic orbital reconstructions are challenging. Portable computed tomography (CT) provides the option to acquire real-time, intraoperative images that help to detect the insufficient reconstruction of the orbit immediately. We retrospectively analyzed patients who received intraoperative CT imaging and analyzed the effect of intraoperative CT scans on revision rates and orbital volume changes before, during, and after surgery. Methods: From August 2014 to September 2016, eleven patients received intraoperative cone-beam CT scans to evaluate the results of secondary orbit reconstruction using Medpor + titanium implants. Patient demographics, surgical details, CT scanning protocol, and follow-up results were analyzed. 3D CT volumetry was used to analyze the orbital volume based on OsiriX MD software. Results: Based on intraoperative CT findings, seven cases required intraoperative revision to further augment the orbital cavity or adjust implants. The mean preoperative measured enophthalmos was 3.41 ±1.4 mm (range: 2-6 mm), which decreased to 0.73 ±0.4 mm (range: 0-1 mm) at postop assessment (p < 0.0001). On the fracture side, there was a significant difference between preoperative vs. intraoperative and preoperative vs. postoperative volume measurements (p < 0.01 for both subsets), but no significant difference between intraoperative vs. postoperative measurements.
Three-Dimensional diagnosis in orbital reconstructive surgery
Annals of Maxillofacial Surgery, 2020
Orbital blow-out fractures are the most common type of fractures among mid-face and typically are the result of blunt trauma. [1-7] Generally, the forces required to break the superior and lateral walls are greater than one required for thin medial and inferior walls. Disruption of any of these structures may lead to expansion of orbital volume and may result in enophthalmos, diplopia, and impaired ocular mobility. [7] The gold standard of orbital wall fracture treatment is surgical reconstruction, with fracture site exposure, freeing tissue prolapsed into the fracture site, and re-approximating of the orbital wall support, usually with an orbital implant. [1] It is usually achieved by transconjunctival, subciliary, and coronal approaches and implementation of graft and reconstructive materials, including bones, cartilage, titanium, and resorbable mesh. [8,9] One of the most important issues related to surgical reconstruction of the orbit is its precise preoperative planning. Conventionally, it was done by means of clinical evaluation, function test, and conventional radiology, including computed tomography (CT) scan. Nevertheless, CT data could be represented as three-dimensional (3D) imaging, which is hard to apply in orbital reconstruction cases. Recent advances in computer technology allows the operator to manipulate CT scan data and produce patient-specific virtual planning as well as plastic models and customized implant materials. [9]
Intraoperative Computed Tomography Scan for Orbital Fracture Reconstruction
Journal of Craniofacial Surgery, 2019
Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.
Cosmetics
Virtual planning is ideally suited for maxillofacial operations as it allows the surgeon to assess the bony and critical neurovascular structures and enables him to plan osteotomies and fracture reductions. This study aims to propose the use of titanium-based patient-specific implants (PSI), along with virtual surgical planning to assess the advantages and the complications in a case of orbital reconstruction. A three-dimensional model of the skull was generated using computed tomography (CT) data of a female patient using Mimics software (version 19, Materialize, Leuven, Belgium). Numerical PSI models were designed using 3-Matic software (version 13, Materialize, Leuven, Belgium) and the non-affected orbit as a template. Surgical virtual planning showed the suitability of the use of the numerical models in traumatic surgical rehabilitation. Moreover, the digital printing process enabled the trial of the designed PSIs on the patient’s face before the surgery. Reconstruction Biomecha...
The Journal of craniofacial surgery, 2015
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. 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. 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. In 6 of the 10 patients, diplopia completely disappeared immediatel...
Computer-aided reconstruction of traumatic fronto-orbital osseous defects: aesthetic considerations
Chang Gung medical journal, 2004
In addition to functional goals, a satisfactory aesthetic outcome is important for reconstruction of fronto-orbital osseous defects. The purpose of this study is to report on a method for presurgical fabrication of custom implants using 3-dimensional (3-D) imaging data and computer-assisted manufacturing techniques. Preoperative 3-D computed tomography data were processed and displayed for evaluation of defects. Implants were created by a computer-aided design/computer-aided manufacturing (CAD/CAM) program. A rapid prototyping system was applied for production of the physical models. Rehearsal of surgery was performed using the implants and skull models. Negative castings were created and were used during the operations to prepare the surgical implant utilizing methyl methacrylate. Traumatic fronto-orbital defects in 4 patients were reconstructed using this method. The follow-up period ranged from 29 to 55 months. Results showed that the custom implants perfectly fit the defects dur...
International Medical Case Reports Journal, 2016
Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D) computer imaging, virtual planning, and 3D printing have become accepted components of the preoperative planning and design phase of treatment. Computer-aided design and computer-assisted manufacture that employ conebeam computed tomography data offer benefits to patient treatment by contributing to greater predictability and improved treatment efficiencies with more reliable outcomes in surgical and prosthetic reconstruction. 3D printing enables transfer of the virtual surgical plan to the operating room by fabrication of surgical guides. Previous studies have shown that accuracy improves considerably with guided implantation when compared to conventional template or freehand implant placement. This clinical case report demonstrates the use of a 3D technological pathway for preoperative virtual planning through prosthesis fabrication, utilizing 3D printing, for a patient with an acquired orbital defect that was restored with an implant-retained silicone orbital prosthesis.