1
|
D’Alpaos D, Badiali G, Ceccariglia F, Tarsitano A. Delayed Orbital Floor Reconstruction Using Mirroring Technique and Patient-Specific Implants: Proof of Concept. J Pers Med 2024; 14:459. [PMID: 38793041 PMCID: PMC11122088 DOI: 10.3390/jpm14050459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3-6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction.
Collapse
Affiliation(s)
- Diana D’Alpaos
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
| | - Giovanni Badiali
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy
| | - Francesco Ceccariglia
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
| | - Achille Tarsitano
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero—University of Bologna, Via Albertoni 15, 40138 Bologna, Italy; (G.B.); (F.C.); (A.T.)
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy
| |
Collapse
|
2
|
Vasile VA, Pirvulescu RA, Iancu RC, Garhöfer G, Schmetterer L, Ghita AM, Ionescu D, Istrate S, Piticescu RM, Cursaru LM, Popa-Cherecheanu A. Titanium Implants Coated with Hydroxyapatite Used in Orbital Wall Reconstruction-A Literature Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1676. [PMID: 38612189 PMCID: PMC11012370 DOI: 10.3390/ma17071676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
With the increasing incidences of orbital wall injuries, effective reconstruction materials and techniques are imperative for optimal clinical outcomes. In this literature review, we delve into the efficacy and potential advantages of using titanium implants coated with nanostructured hydroxyapatite for the reconstruction of the orbital wall. Titanium implants, recognized for their durability and mechanical strength, when combined with the osteoconductive properties of hydroxyapatite, present a potentially synergistic solution. The purpose of this review was to critically analyze the recent literature and present the state of the art in orbital wall reconstruction using titanium implants coated with nanostructured hydroxyapatite. This review offers clinicians detailed insight into the benefits and potential drawbacks of using titanium implants coated with nanostructured hydroxyapatite for orbital wall reconstruction. The highlighted results advocate for its benefits in terms of osseointegration and provide a novel strategy for orbital reconstruction, though further studies are essential to establish long-term efficacy and address concerns.
Collapse
Affiliation(s)
- Victor A. Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Ruxandra A. Pirvulescu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Raluca C. Iancu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore 637459, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4056 Basel, Switzerland
| | - Aurelian M. Ghita
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Diana Ionescu
- Department of ENT, Children’s Clinical Hospital “Dr. V. Gomoiu”, 022102 Bucharest, Romania
| | | | - Roxana M. Piticescu
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Laura M. Cursaru
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Alina Popa-Cherecheanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.A.V.)
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| |
Collapse
|
3
|
Er S, Hassan B, Yoon J, Resnick E, Yusuf C, Lagziel T, Liang F, Ptak T, Redett R, Yang R, Grant M. Orbital Fracture Characteristics and Outcomes in Baltimore. J Craniofac Surg 2024:00001665-990000000-01420. [PMID: 38534184 DOI: 10.1097/scs.0000000000010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
Fracture characteristics and postoperative outcomes of patients presenting with orbital fractures in Baltimore remain poorly investigated. The purpose of our study was to determine the fracture patterns, etiologies, and postoperative outcomes of patients treated for orbital fractures at 2 level I trauma centers in Baltimore. A retrospective cohort study was conducted on patients who underwent orbital fracture repair at the R Adams Cowley Shock Trauma Center and the Johns Hopkins Hospital from January 2015 to December 2019. Of 374 patients, 179 (47.9%) had orbital fractures due to violent trauma, 252 (67.4%) had moderate to near-total orbital fractures, 345 (92.2%) had orbital floor involvement, and 338 (90.4%) had concomitant neurological symptoms/signs. Almost half of the patients had at least one postoperative ocular symptom/sign [n = 163/333 (48.9%)]. Patients who had orbital fractures due to violent trauma were more likely to develop postoperative ocular symptoms/signs compared with those who had orbital fractures due to nonviolent trauma [n = 88/154 (57.1%), n = 75/179 (41.9%); P = 0.006]. After controlling for factors pertaining to injury severity, there was no significant difference in patient throughput or incidence of any postoperative ocular symptom/sign after repair between the two centers. Timely management of patients with orbital fractures due to violent trauma is crucial to mitigate the risk of postoperative ocular symptoms/signs.
Collapse
Affiliation(s)
- Seray Er
- School of Medicine, University of Maryland
| | - Bashar Hassan
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Joshua Yoon
- Department of Surgery, George Washington University, Washington, DC
| | | | - Cynthia Yusuf
- School of Medicine, University of Maryland
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Fan Liang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Thomas Ptak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Richard Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Michael Grant
- Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center
| |
Collapse
|
4
|
Jeyaraj P. Successful Management of Post-Traumatic Residual Orbital Roof Defects with Cosmetic Disfigurement and Functional Deficits Using Innovative Titanium Plate Orbitoplasty. J Maxillofac Oral Surg 2023; 22:1040-1051. [PMID: 38105810 PMCID: PMC10719227 DOI: 10.1007/s12663-022-01744-z] [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: 12/27/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Late presentations of post-traumatic residual orbital roof deformities ensuing from old, unaddressed orbital injuries, can be extremely challenging to manage and quite complicated to correct, owing to proximity of the brain and frontal sinus, malunion or bony fusion of the displaced, delicate orbital fracture fragments, necrosis of entrapped extraocular muscles and progressive intraorbital soft tissue fibrosis and adhesions. There exists a paucity in literature on delayed repair of displaced and comminuted orbital roof fractures and late reconstruction of the three-dimensional architecture of the orbital frame and internal orbit. Aim & Objectives To present an unusual case of severe post-traumatic residual orbital roof deformity, resulting in longstanding aesthetic disfigurement and persisting functional deficits, and its successful management. Material & Methods The patient had sustained orbital injuries sixteen months ago, on being punched in the face at a boxing tournament. The increased orbital volume produced by an impure blowout fracture of the left orbital roof, with comminution of the upper and lower orbital rims, had resulted in considerable cosmetic deformity, discomfort as well as functional debility, all of which were successfully and efficaciously managed by an innovative use of a Titanium Orbital Plate for orbital roof reconstruction. Discussion Overlooked, undetected or ignored derangements in intraorbital volume and contour, can lead to severe cosmetic disfigurement in the form of enophthalmos, hypoglobus, entropion, telecanthus, palpebral fissure width narrowing and ptosis; in addition to crippling functional deficits, such as diplopia, blurred vision, levator dysfunction, restricted ocular motility and reduced visual range and acuity. Results & Conclusions An innovative Titanium mesh orbitoplasty enabled achievement of both, the aesthetic and functional goals of reconstruction of the distorted bony orbit, with successful correction of severe functional and aesthetic deficits.
Collapse
|
5
|
Lein IÅ, Bjørnland T, Loro LL. Retrospective Study of Orbital and Orbitozygomaticomaxillary Complex Fractures Treated at Aalesund Hospital Between 2002 and 2017. Craniomaxillofac Trauma Reconstr 2023; 16:292-300. [PMID: 38047149 PMCID: PMC10693266 DOI: 10.1177/19433875221135932] [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: 12/05/2023] Open
Abstract
Study Design Retrospective study. Objective To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway. Methods The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 and July 2017 were reviewed. Data on demographics, signs and symptoms, cause of injury, fracture type, associated fractures, surgical management, and complications were collected. Results A total of 36 patients were reviewed. Males predominated (1:4.1), and fractures occurred mostly in patients 40-59 years (mean 41.8 years). Interpersonal violence was the leading cause of injury, followed by falls. Alcohol was significantly associated with assault caused fractures (P = .001). Orbitozygomaticomaxillary fractures were the most frequent, followed by pure orbital fractures. Clinical findings included periorbital ecchymosis (72%), swelling (56%), sensory nerve dysfunction (53%), diplopia (22%), and restricted eye motility (22%). Commotio cerebri was observed in more than half of our sample and 47% had other facial bone fractures. Referral to tertiary hospitals was done in 19% of the cases. The main treatment done was open reduction and internal fixation (ORIF) (45%). Infection was diagnosed in 17% and managed with antibiotics. Conclusions The incidence of orbital and OZMC fractures in Moere and Romsdal county in western Norway was low, occurring mainly in males over 40 years. The mechanism of injury was predominantly interpersonal violence and falls. A high proportion of the sample had minor traumatic brain injury (mTBI).
Collapse
Affiliation(s)
- Ingvild Årøen Lein
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lado Lako Loro
- Section of Maxillofacial Surgery, Department of Clinical Surgery, Aalesund Hospital, Moere and Romsdal Hospital Trust, Aalesund, Norway
| |
Collapse
|
6
|
Kwofie M, Policeni B. Reconstructive Surgeries After Head And Neck Trauma: Imaging Appearances. Semin Roentgenol 2023; 58:311-330. [PMID: 37507172 DOI: 10.1053/j.ro.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Michael Kwofie
- Department of Radiology, The University of Iowa Hospital and Clinics, Iowa City, IA.
| | - Bruno Policeni
- Department of Radiology, The University of Iowa Hospital and Clinics, Iowa City, IA
| |
Collapse
|
7
|
Megafu MN, Megafu EC, Nguyen JT, Mian HS, Singhal SS, Parisien RL. The Statistical Fragility of Orbital Fractures: A Systematic Review of Randomized Controlled Trials. J Oral Maxillofac Surg 2023:S0278-2391(23)00209-4. [PMID: 36931316 DOI: 10.1016/j.joms.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The P value has often been used as a tool to determine the statistical significance and evaluate the statistical robustness of study findings in orthopedic literature. The purpose of this study is to apply both the fragility index (FI) and the fragility quotient (FQ) to evaluate the degree of statistical fragility in orbital fracture literature. We hypothesized that the dichotomous outcomes within the orbital fracture literature will be vulnerable to a small number of outcome event reversals and will be statistically fragile. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors identified all dichotomous data for randomized controlled trials (RCTs) in orbital fracture literature and performed a PubMed search from 2000 to 2022. The FI of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each FI by study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. RESULTS Of the 3,329 studies screened, 28 met the criteria with 10 RCTs evaluating orbital fractures included for analysis. A total of 58 outcome events with 22 significant (P < .05) outcomes and 36 nonsignificant (P ≥ .05) outcomes were identified. The overall FI and FQ for all 58 outcomes was 5 (IQR: 4 to 5) and 0.140 (IQR: 0.075 to 0.250), respectively. Fragility analysis of statistical significant outcomes and nonsignificant outcomes had an FI of 3.5 with no IQR and 5 (IQR 4-5), respectively. All of the studies reported a loss to follow-up data, where 20% (2) was greater than the overall FI of 5. CONCLUSION The orbital fracture literature provides treatment guidance by relying on statistical significant results from RCTs. However, the RCTs in the orbital fracture peer-reviewed literature may not be statistically stable as previously thought. The sole reliance of the P value may depict misleading results. Thus, we recommend standardizing the reporting of the P value, FI, and FQ in the orbital fracture literature to aid readers in reliably drawing conclusions based on fragility outcome measures impacting clinical decision-making.
Collapse
Affiliation(s)
- Michael N Megafu
- A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, MO.
| | | | | | - Hassan S Mian
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN
| | | | - Robert L Parisien
- Mount Sinai Hospital, Department of Orthopedic Surgery, New York, NY
| |
Collapse
|
8
|
Piombino P, Troise S, Maglitto F, Barone S, Sani L, Committeri U, Norino G, Bonavolontà P, Salzano G, Vaira LA, De Riu G, Califano L. Management of Orbital Floor Fractures: Our Experience in 10 Years. Indian J Otolaryngol Head Neck Surg 2022; 74:547-554. [PMID: 36514430 PMCID: PMC9741679 DOI: 10.1007/s12070-022-03127-9] [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: 12/26/2021] [Accepted: 07/10/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Orbital floor Fractures are the most common fractures involving the facial skeleton and usually occurs after traumatic events. The reconstruction of the orbital floor can be performed with different biocompatible materials. The aim of our retrospective study is to analyze the short- and long-term outcomes of surgically treated patients based on the material used to repair the orbital floor. Methods We enrolled 146 patients hospitalized for orbital floor fractures in the Maxillofacial Surgery Unit of the Federico II University of Naples from 1 to 2010 to July 2020. All the fractured orbital floors were reconstructed with non-resorbable (Titanium Mesh, SynPor, SuPor and MedPor implants) or resorbable (collagen membrane, bovinum pericardium membrane, autologous bone graft) materials. Results We utilized non-resorbable materials in 56% (82 cases) and resorbable implants in 44% (64 cases). An improvement of the preoperative symptomatology and an aesthetical good outcome was achieved in most cases. Conclusions Data obtained supports that both resorbable and non-resorbable materials for orbital floor reconstruction are a safe and effective alternatives and offer satisfactory results in functional and aesthetic evaluations.
Collapse
Affiliation(s)
- Pasquale Piombino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Stefania Troise
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Fabio Maglitto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Simona Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Lorenzo Sani
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Umberto Committeri
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanna Norino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Paola Bonavolontà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Salzano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Luigi Califano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| |
Collapse
|
9
|
Boro S, Suri MP, Mathew AK. PDS Plate Versus Bone Graft in Orbital Floor Reconstruction: A Prospective Study to Identify the Better Alternative. Indian J Otolaryngol Head Neck Surg 2022; 74:4699-4705. [PMID: 36742492 PMCID: PMC9895357 DOI: 10.1007/s12070-021-03036-3] [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: 09/20/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
The objective of this study is to compare the effect and outcome of orbital floor reconstruction with bone graft and PDS plate. A prospective cohort study was conducted at B J Medical College, Civil Hospital, Ahmedabad from 1st September 2013 to 28th February 2016 by the Department of Burns and Plastic Surgery on patients (N = 35) who reported with orbital floor fracture. Diplopia, enophthalmos, infection rate, hospital stay, and donor site complications were considered. The above variables were assessed as predictors of outcome in the management (PDS vs. bone graft). Inferential statistics was done by chi-square test. The significance level was kept at 5%. Follow-up of 35 patients (2 years), 26 male, and 9 females aged 26-65 years were made. Diplopia and enophthalmos were the main criteria's in the study and neither of them showed any statistical significance. Donor site morbidity was noted in 3 patients among the bone graft group which was managed conservatively. Both the bone graft and PDS plate in orbital floor reconstruction is comparable in almost all aspects of our study. No statistically significant differences were found between the two groups. Pain and wound site infection are possible complications when a bone graft is used as the reconstructive option.
Collapse
Affiliation(s)
- Sumanjith Boro
- Department of Plastic and Reconstructive surgery, Dr B Borooah Cancer Institute, Guwahati, A Unit of TMC and a Grant-in-Aid institute of DAE, Mumbai, India
| | - Manav P. Suri
- Department of Plastic and Reconstructive Surgery, BJ Medical College, Ahmedabad, India
| | - Anil K. Mathew
- Department of Plastic and Reconstructive surgery, Dr B Borooah Cancer Institute, Guwahati, A Unit of TMC and a Grant-in-Aid institute of DAE, Mumbai, India
| |
Collapse
|
10
|
Fawzy HH, Saber AF, Nassar AT, Eid KA, Ghareeb FM. Technical considerations of computer-aided planning in severe orbital trauma: A retrospective study. J Craniomaxillofac Surg 2022; 50:873-883. [PMID: 36681615 DOI: 10.1016/j.jcms.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 11/11/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to evaluate the clinical outcomes of linear and orbital volume measurements in severe orbital trauma. Patients with severe orbital trauma that involved more than two walls and entailed a marked degree of comminution were included in this retrospective analysis. However, patients with incomplete clinical records and a simple blowout or zygmatico-orbital fractures were excluded. All the cases underwent surgical correction guided by virtual surgical planning and 3D-printed templates. The measurement protocol depended on assessing orbital dimensions, orbital volumetry, and the zygomatic bone's position in the three-dimensional planes. All patients' preoperative 3D CT scans were obtained, and DICOM files were imported into a three-dimensional image processing software. Data were then converted for 3D reconstruction in the axial, coronal, and sagittal views. A total of 18 patients with a mean age was 39.28 ± 6.28 were included in this study. The results revealed a significant difference between the pre and postoperative differences in distances in relation to the FHP (Frankfurt Horizontal Plane) (P = 0.0014) and sagittal planes (P < 0.0001). The orbital width and height of the traumatized orbit were significantly decreased from 45.26 ± 6.72 mm and 45.30 ± 2.89 mm to 39.74 ± 3.91 mm (P = 0.0022), and 40.34 ± 0.86 mm (P < 0.0001), respectively. Clinically, there was a satisfactory degree of symmetry regarding the zygomatic bones' position and orbital dimensions postoperatively. Moreover, the mean orbital volume on the traumatized side decreased significantly from 23.16 ± 1.91 cm3 preoperatively to 20.7 ± 1.96 cm3 postoperatively (P < 0.0001). These findings were associated with a low incidence of complications. Within the limitations of the study it seems that the described methodology is a relevant addition to clinical treatment options. It incorporates all the latest technology to plan virtual reconstruction surgery in the treatment of complex orbital trauma and should be adapted accordingly in cases of severe displacement and comminution.
Collapse
Affiliation(s)
- Hossam Hassan Fawzy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Ahmed Fergany Saber
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Tharwat Nassar
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Fouad Mohamed Ghareeb
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| |
Collapse
|
11
|
Amarath-Madav R, Adamkiewicz D, Bigler D, Yu JC, Lima MH. White-Eyed Orbital Blowout Fracture With Oculocardiac Reflex Secondary to Extraocular Entrapment in a Pediatric Patient. J Craniofac Surg 2022; 33:e767-e771. [PMID: 36109010 DOI: 10.1097/scs.0000000000008713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
White-eyed orbital blowout fractures in the pediatric population can present with acute onset diplopia, ophthalmalgia, and abnormal duction. These findings are attributed to the tendency of younger bone to break and reapproximate owing to greater elasticity. This phenomenon, commonly referred to as the greenstick fracture, increases the risk of entrapment of surrounding soft tissue structures in orbital floor fractures. Further concern arises in the presence of an oculocardiac reflex, which requires urgent intervention to prevent serious bradycardia. Prolonged entrapment can go unnoticed and result in irreversible ischemic damage to entrapped tissues. This case discusses the presentation 16-year-old female who sustained a left sided, white-eyed blowout fracture from a face-first ground level fall. On admission, she displayed restrictive strabismus and mild periorbital edema around the left eye. Vertical gaze was restricted when looking inferiorly on the affected side. With sustained upward gaze, her heart rate decreased from 99 to 81 beats per minute. High-resolution non-contrast computed tomography scans of the head showed entrapment of the inferior rectus muscle and periorbital fat. Liberation of entrapped tissues with reduction of bony segments was performed urgently, utilizing a MEDPOR® Titan 3D orbital floor plate and secured with two screws. The patient had an uneventful postoperative period and showed considerable improvements in periorbital edema, duction, and ophthalmalgia on the affected side. In addition, the oculocardiac reflex could no longer be elicited on prolonged upward gaze. Mild and improving paresthesia was noted in the maxillary distribution of the left trigeminal nerve. Sensory deficits like this are the result of fracture communication with the infraorbital canal, which may cause irritation of the infraorbital nerve responsible for sensation by the maxillary division. By postoperative week 7, she had complete resolution of periorbital edema, indiscernible duction abnormalities, and complete healing of surgical incision sites, and an oculocardiac reflex could not be elicited.
Collapse
Affiliation(s)
| | | | - Diana Bigler
- Medical College of Georgia, Department of Otolaryngology
| | - Jack C Yu
- Medical College of Georgia, Department of Plastic Surgery, Augusta, GA
| | - Maria Helena Lima
- Medical College of Georgia, Department of Plastic Surgery, Augusta, GA
| |
Collapse
|
12
|
Rana M, Moellmann HL, Schorn L, Lommen J, Rana M, Wilkat M, Hufendiek K. Primary Orbital Reconstruction with Selective Laser Melting (SLM) of Patient-Specific Implants (PSIs): An Overview of 96 Surgically Treated Patients. J Clin Med 2022; 11:jcm11123361. [PMID: 35743432 PMCID: PMC9224837 DOI: 10.3390/jcm11123361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/27/2023] Open
Abstract
Contemporary advances in technology have allowed the transfer of knowledge from industrial laser melting systems to surgery; such an approach could increase the degree of accuracy in orbital restoration. The aim of this study was to examine the accuracy of selective laser melted PSIs (patient-specific implants) and navigation in primary orbital reconstruction. Ninety-six patients with orbital fractures were included in this study. Planned vs. achieved orbital volumes (a) and angles (b) were compared to the unaffected side (n = 96). The analysis included the overlay of post-treatment on planned images (iPlan 3.0.5, Brainlab®, Feldkirchen, Germany). The mean difference in orbital volume between the digitally planned orbit and the postoperative orbit was 29.16 cm3 (SD 3.54, presurgical) to 28.33 cm3 (SD 3.64, postsurgical, t = 5.00, df = 95.00; p < 0.001), resulting in a mean volume difference (planned vs. postop) of less than 1 cm3. A 3D analysis of the color mapping showed minor deviations compared to the mirrored unaffected side. The results suggested that primary reconstruction in complex orbital wall fractures can be routinely achieved with a high degree of accuracy by using selective laser melted orbital PSIs.
Collapse
Affiliation(s)
- Majeed Rana
- Department of Oral and Maxillofacial Surgery, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany; (M.R.); (L.S.); (J.L.); (M.W.)
| | - Henriette L. Moellmann
- Department of Oral and Maxillofacial Surgery, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany; (M.R.); (L.S.); (J.L.); (M.W.)
- Correspondence:
| | - Lara Schorn
- Department of Oral and Maxillofacial Surgery, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany; (M.R.); (L.S.); (J.L.); (M.W.)
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany; (M.R.); (L.S.); (J.L.); (M.W.)
| | - Madiha Rana
- Department of Psychology, University of Applied Sciences, Doberaner Weg 20, 22143 Hamburg, Germany;
| | - Max Wilkat
- Department of Oral and Maxillofacial Surgery, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany; (M.R.); (L.S.); (J.L.); (M.W.)
| | - Karsten Hufendiek
- Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany;
| |
Collapse
|
13
|
Chattopadhyay C, Dev V, Pilania D, Harsh A. Reconstruction of Orbital Floor Fractures with Titanium Micromesh: Our Experience. J Maxillofac Oral Surg 2022; 21:369-378. [DOI: 10.1007/s12663-020-01407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022] Open
|
14
|
Customized and Navigated Primary Orbital Fracture Reconstruction: Computerized Operation Neuronavigated Surgery Orbital Recent Trauma (CONSORT) Protocol. J Craniofac Surg 2022; 33:1236-1240. [PMID: 34999613 DOI: 10.1097/scs.0000000000008461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Combined orbital medial wall and floor fractures and large isolated orbital floor fractures commonly require surgical treatment due to the high probability of diplopia and enophthalmos. Primary reconstruction of these orbital fractures requires a high-level surgeon with a great amount of technical surgical skill. The use of novel technology can greatly improve the accuracy of reconstruction and achieve satisfactory clinical outcomes. Hence, the authors aimed to present our findings and overall experience with respect to extensive floor and medial wall orbital fracture reconstruction according to the Computerized Operation Neuronavigated Surgery Orbital Recent Trauma (CONSORT) protocol, a workflow designed for the primary reconstruction of orbital fractures with customized mesh and intraoperative navigation. A total of 25 consecutively presenting patients presenting with unilateral extensive orbital floor fractures and orbital floor and medial wall fractures were treated following the CONSORT workflow from January 2017 to March 2020. Fractures were surgically treated with a customized implant and intraoperative navigation. Patients underwent surgery within 14 days of the trauma injury. Preoperative and postoperative functional and aesthetic outcomes are described herein. All fractures were successfully reconstructed. Postoperatively, all 19 patients with preoperative diplopia reported the resolution of diplopia. Enophthalmos resolved in 18/20 cases. No patients had major complications during follow-up. Thus, the authors conclude that the CONSORT protocol introduced by the authors is an adaptable and reliable workflow for the early treatment of orbital fractures and can clearly optimize functional and aesthetic outcomes, reduce costs and intensive time commitments, and make customized and navigated surgery more available for institutions.
Collapse
|
15
|
Ocular Trauma. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
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.
Collapse
|
17
|
Gass M, Füßinger MA, Metzger MC, Schwarz S, Bähr JD, Brandenburg L, Weingart J, Schlager S. Virtual reconstruction of orbital floor defects using a statistical shape model. J Anat 2021; 240:323-329. [PMID: 34658032 PMCID: PMC8742960 DOI: 10.1111/joa.13550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/03/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The current standard in reconstructing defects of the orbital floor, by using the concept of mirroring, is time-consuming and ignores the natural asymmetry of the skull. By using a statistical shape model (SSM), the reconstruction can be automatized and improved in accuracy. The present study aims to show the possibilities of the virtual reconstruction of artificial defects of the orbital floor using an SSM and its potentials for clinical implementation. METHODS Based on 131 unaffected CT scans of the midface, an SSM was created which contained the shape variability of the orbital floor. Nineteen midface CT scans, that were not included in the SSM, were manually segmented to establish ground truth (control group). Then artificial defects of larger and smaller sizes were created and reconstructed using SSM (Group I) and the gold standard of mirroring (Group II). Eventually, a comparison to the surface of the manual segmentation (control group) was performed. RESULTS The proposed method of reconstruction using an SSM leads to more precise reconstruction results, compared with the conventional method of mirroring. Whereas mirroring led to the reconstruction errors of 0.7 mm for small defects and 0.73 mm for large defects, reconstruction using SSM led to deviations of 0.26 mm (small defect) and, respectively, 0.34 mm (large defect). CONCLUSIONS The presented approach is an effective and accurate method for reconstructing the orbital floor. In connection with modern computer-aided design and manufacturing, individual patient-specific implants could be produced according to SSM-based reconstructions and could replace current methods using manual bending techniques. By acknowledging the natural asymmetry of the human skull, the SSM-based approach achieves higher accuracy in reconstructing injured orbits.
Collapse
Affiliation(s)
- Mathieu Gass
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Marc Anton Füßinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Steffen Schwarz
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Johannes Daniel Bähr
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Leonard Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Julia Weingart
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
Influence of fractures in different inferior orbital wall locations on ocular motility disorders. Chin Med J (Engl) 2021; 134:2632-2634. [PMID: 34748528 PMCID: PMC8577677 DOI: 10.1097/cm9.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
19
|
Ghosh SK, Narayan RK. Fractures involving bony orbit: A comprehensive review of relevant clinical anatomy. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
20
|
Baviskar PS, Natarajan S. Use of custom fabricated surgical jig to improve surgical outcomes in open reduction internal fixation of unilateral orbital fractures: A prospective clinical study. Saudi J Ophthalmol 2021; 35:244-250. [PMID: 35601861 PMCID: PMC9116094 DOI: 10.4103/sjopt.sjopt_49_20] [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: 11/30/2020] [Revised: 06/28/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of the study was to assess the efficacy of virtual planning and surgical guide jig to improve surgical outcomes of open reduction and internal fixation with restoration and correction of orbital volume (OV) in unilateral orbital wall fractures. METHODS Fifteen patients with unilateral orbital fractures were assessed with ophthalmologic and radiographic parameters. The orbit was divided into three zones on computed tomography to localize defects. Fractures were coded into Fx Mx Rx Lx (F = Orbital Floor, M = Medial Wall, L = Lateral wall, R = Orbital Roof) based on pattern and specific wall involved. 1-mm sections were used to make stereolithographic models, design the custom fabricated surgical jig for intraoperative use as a guide. RESULTS Pre- and postoperative ophthalmological parameters, OV, were compared with the contralateral normal orbit serving as the reference. Postoperative ophthalmological parameters showed significant improvement in terms of visual acuity, enophthalmos, dystopia, and traumatic optic neuropathy. OV changes were concentrated in Zones 2 and 3. OV showed adequate restoration postoperatively. CONCLUSION The surgical jig served as an efficient guide to improve surgical outcomes of open reduction internal fixation. Preplanned intraoperative positioning helped achieve adequate anatomical reduction and fixation with an adequate reconstruction of OV aiding the effective transfer of virtual surgical plan on the table with improved surgical outcomes in clinical performance and functional restitution.Clinical trial registration: The Clinical Trials Registry of India (CTRI) Registration No.: CTRI/2019/11/021929.
Collapse
Affiliation(s)
- Padmakar S. Baviskar
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Sector 01, Navi Mumbai, Maharashtra, India
| | - Srivalli Natarajan
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Kamothe, Sector 01, Navi Mumbai, Maharashtra, India
| |
Collapse
|
21
|
Abstract
BACKGROUND Fractures of the orbital roof require high-energy trauma and have been linked to high rates of neurologic and ocular complications. However, there is a paucity of literature exploring the association between injury, management, and visual prognosis. METHODS The authors performed a 3-year retrospective review of orbital roof fracture admissions to a Level I trauma center. Fracture displacement, comminution, and frontobasal type were ascertained from computed tomographic images. Pretreatment characteristics of operative orbital roof fractures were compared to those of nonoperative fractures. Risk factors for ophthalmologic complications were assessed using univariable/multivariable regression analyses. RESULTS In total, 225 patients fulfilled the inclusion criteria. Fractures were most commonly nondisplaced [n = 118 (52.4 percent)] and/or of type II frontobasal pattern (linear vault involving) [n = 100 (48.5 percent)]. Eight patients underwent open reduction and internal fixation of their orbital roof fractures (14.0 percent of displaced fractures). All repairs took place within 10 days from injury. Traumatic optic neuropathy [n = 19 (12.3 percent)] and retrobulbar hematoma [n = 11 (7.1 percent)] were the most common ophthalmologic complications, and led to long-term visual impairment in 51.6 percent of cases. CONCLUSIONS Most orbital roof fractures can be managed conservatively, with no patients in this cohort incurring long-term fracture-related complications or returning for secondary treatment. Early fracture treatment is safe and may be beneficial in patients with vertical dysmotility, globe malposition, and/or a defect surface area larger than 4 cm2. Ophthalmologic prognosis is generally favorable; however, traumatic optic neuropathy is major cause of worse visual outcome in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
22
|
Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients. J Craniofac Surg 2021; 32:1334-1337. [PMID: 33405442 DOI: 10.1097/scs.0000000000007384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.
Collapse
|
23
|
Zeller AN, Neuhaus MT, Gessler N, Skade S, Korn P, Jehn P, Gellrich NC, Zimmerer RM. Self-centering second-generation patient-specific functionalized implants for deep orbital reconstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:372-380. [PMID: 33385579 DOI: 10.1016/j.jormas.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Deep and complete reconstruction of the orbital cavity has been shown to be essential for preventing enophthalmos and hypoglobus in patients with orbital defects or deformities. Additively manufactured patient-specific titanium implants provide unlimited options in design. However, implant malpositioning can still occur, even when intraoperative imaging and navigation are used. In this study, we investigated novel orbital implants containing features facilitating self-centering. Accuracy of implant placement and reconstruction of the orbital dimensions were compared retrospectively between self-centering second-generation patient-specific functionalized orbital implants (study group) and CAD-based individualized implants (control group). Design features of implants in the study group included functionalization with navigation tracks, a preventive design, and flanges - so called stabilizers - towards opposite orbital walls. Implant position was evaluated by fusion of preoperative virtual plans and the post-therapeutic imaging. Aberrances were quantified by 3D heatmap analysis. 31 patients were assigned to the study group and 50 to the control group, respectively. In the study group, most implants were designed with either one (n = 18, 58.06%) or two (n = 10, 32.26%) stabilizers. Twice (6.45%), one stabilizer had to be shortened intraoperatively. Implant fit analysis revealed a significantly more precise (p < 0.001) positioning in the study group (n = 22/31) than in the control group (n = 42/50). Self-centering second-generation patient-specific functionalized orbital implants showed significantly more accurate implant positioning, facilitating the transformation of virtual plans into patient's anatomy. The presented design provides an additional instrument for intraoperative quality control besides intraoperative imaging and navigation.
Collapse
Affiliation(s)
| | - Michael Tobias Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nora Gessler
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Sandra Skade
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Rüdiger M Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
| |
Collapse
|
24
|
Lucas JP, Allen M, Nguyen BK, Svider PF, Folbe AJ, Carron M. Orbital Roof Fractures: An Evidence-Based Approach. Facial Plast Surg Aesthet Med 2020; 22:471-480. [DOI: 10.1089/fpsam.2020.0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordyn P. Lucas
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Meredith Allen
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Brandon K. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Peter F. Svider
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Adam J. Folbe
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Michael Carron
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
| |
Collapse
|
25
|
Moon SJ, Lee WJ, Roh TS, Baek W. Sex-related and racial variations in orbital floor anatomy. Arch Craniofac Surg 2020; 21:219-224. [PMID: 32867410 PMCID: PMC7463127 DOI: 10.7181/acfs.2020.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/01/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Repair of the orbital floor following trauma or tumor removal remains a challenge because of its complex three-dimensional shape. The purpose of the present study is to understand normal orbital floor anatomy by investigating its differences across four groups (Caucasian American and East Asian, males and females) via facial bone computed tomography (CT). METHODS A total of 48 orbits in 24 patients between 20 and 60 years of age were evaluated. Although most patients underwent CT scanning following trauma, the orbital walls were intact in all patients. Linear and angular measurements of the orbital floor were obtained from CT images. RESULTS Orbital floor width, length, angle between the orbital floor and medial wall, and distance from the inferior orbital rim to the lowest point of the orbital floor did not show a statistically significant difference between groups. Angles made by the infraorbital rim, the lowest point of the floor, and the anterior border of the infraorbital fissure were statistically significantly wider in East Asian females than in male groups. The floor depth in East Asian females was significantly smaller compared to all the other groups. CONCLUSION East Asian female population had smaller curvature and depth of an orbital floor than the other groups, which means racial and sex-related differences should be considered in the orbital floor reconstruction.
Collapse
Affiliation(s)
- Seung Jin Moon
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Wooyeol Baek
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Cornelius CP, Stiebler T, Mayer P, Smolka W, Kunz C, Hammer B, Jaquiéry C C, Buitrago-Téllez C, Leiggener CS, Metzger MC, Wilde F, Audigé L, Probst M, Strong EB, Castelletti N, Prein J, Probst FA. Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions. J Craniomaxillofac Surg 2020; 49:598-612. [PMID: 34020871 DOI: 10.1016/j.jcms.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/09/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification. MATERIAL AND METHODS CT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the "defect body" method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis. RESULTS A total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures - W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm2 to 6.09 cm2 for orbital floor and from 0.29 cm2 to 5.43 cm2 for medial wall fractures. The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm2, W2(i) = 1.64 cm2, W1(i)2(i) = 3.10 cm2, W1(m) = 1.36 cm2, W2(m) = 1.65 cm2, W1(m)2(m) = 2.98 cm2, W1 (im) = 3.35 cm2, W1 (im) 2(i) = 4.63 cm2, W1 (im)2(m) = 4.06 cm2 and W1 (im)2 (im) = 7.16 cm2. CONCLUSION The AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.
Collapse
Affiliation(s)
- Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Tobias Stiebler
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Peter Mayer
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany
| | - Christoph Kunz
- Clinic for Craniomaxillofacial and Oral Surgery, University Hospital, Basel, Switzerland
| | - Beat Hammer
- Craniofacial Center (CFC) Hirslanden Medical Center Aarau, Switzerland
| | - Claude Jaquiéry C
- Clinic for Craniomaxillofacial and Oral Surgery, University Hospital, Basel, Switzerland
| | | | | | - Marc Christian Metzger
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Germany
| | - Frank Wilde
- Department of Oral and Plastic Maxillofacial Surgery, Armed Forces Hospital and University Hospital Ulm, Germany
| | - Laurent Audigé
- Statistical Research and Development, Schulthess Clinic, Upper Extremities, Zürich, Switzerland
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Medical School Munich, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Noemi Castelletti
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-University, Munich, Germany
| | - Joachim Prein
- Clinic for Craniomaxillofacial and Oral Surgery, University Hospital, Basel, Switzerland
| | - Florian Andreas Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Munich, Germany.
| |
Collapse
|
27
|
Amin D, Al-Mulki K, Henriquez OA, Cheng A, Roser S, Abramowicz S. Review of Orbital Fractures in an Urban Level I Trauma Center. Craniomaxillofac Trauma Reconstr 2020; 13:174-179. [PMID: 33456683 DOI: 10.1177/1943387520924515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To perform a comprehensive review and analysis of surgically treated orbital fractures. Study Design Retrospective cohort chart review study for surgically treated orbital fractures during 5 years. Results A total of 173 patients (average age 41.6 years) were diagnosed with orbital fractures. Most were male with a ratio of 3.3:1. Most fractures were caused by assault (39.3%); 22.5% of the cases were bilateral. The left orbit (40.5%) was fractured more than the right. The orbital floor (97.1%) was the most common anatomic location and the maxilla (65.3%) was the most commonly involved bone. The average time from trauma to surgical intervention was 8.7 ± 14.6 days and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision (63%) was the most commonly used incision, and nonresorbable implant (92.7%) was the most commonly used implant. Finally, the length of stay for the repair of a simple orbital fracture was less than for complex orbital fracture (1.5 days and 5.9 days, respectively). Conclusion Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for a uniform high quality of surgical care for patients with maxillofacial fractures.
Collapse
Affiliation(s)
- Dina Amin
- Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Kareem Al-Mulki
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Oswaldo A Henriquez
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Angela Cheng
- Division of Plastic Surgery, Department of General Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Roser
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
28
|
|
29
|
Kang JM, Kalin-Hajdu E, Idowu OO, Vagefi MR, Kersten RC. Nasolacrimal Obstruction Following the Placement of Maxillofacial Hardware. Craniomaxillofac Trauma Reconstr 2020; 13:32-37. [PMID: 32642029 DOI: 10.1177/1943387520906004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.
Collapse
Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| |
Collapse
|
30
|
Meredith TJ, Embry S, Hunter R, Noble B. Ocular Trauma. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Kim JH, Lee IG, Lee JS, Oh DY, Jun YJ, Rhie JW, Shim JH, Moon SH. Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant. J Anat 2019; 236:923-930. [PMID: 31852015 DOI: 10.1111/joa.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/13/2022] Open
Abstract
The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre ), and Vpost compared with Vpre also showed a statistically significant difference (P < 0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.
Collapse
Affiliation(s)
- Jun Hyeok Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - In-Gyu Lee
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea
| | - Jeong-Seok Lee
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea
| | - Deuk Young Oh
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Young Joon Jun
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jong Won Rhie
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Jin-Hyung Shim
- Department of Mechanical Engineering, Korea Polytechnic University, Siheung, Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea
| |
Collapse
|
32
|
RETRACTED: The association between metformin therapy and risk of gynecological cancer in patients: two meta-analyses. Br J Oral Maxillofac Surg 2019; 57:782-787. [DOI: 10.1016/j.bjoms.2019.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/12/2019] [Indexed: 11/19/2022]
|
33
|
Abstract
Purpose: Vision loss after orbital surgery is one of the most dreaded complications faced by the orbitofacial surgeon. This literature review was conducted in an attempt to determine the risk factors for severe vision loss and discuss the applied anatomy related to various types of orbital surgery - orbital tumor excisions, orbital decompression, and post-traumatic orbital reconstruction.Methods: A literature search was conducted via PubMed and Google Scholar. All cases of vision loss following orbital tumor biopsy or excision, orbital decompression, and orbital trauma reconstruction were reviewed.Results: The incidence of postoperative blindness appears to be more after orbital tumor excisions (4.7%), compared to post-traumatic orbital reconstruction (2.08%) and orbital decompressions for thyroid orbitopathy (0.15%).The causes of vision loss include ischemic optic neuropathy, traumatic optic neuropathy, retinal and ophthalmic artery occlusions, and orbital compartment syndrome.Conclusion: Apart from careful patient selection, proper counseling about the risk of postoperative blindness is of utmost importance. Detailed preoperative treatment planning, meticulous atraumatic intraoperative dissection under direct visualization, with attention to the danger zones and vital structures, close intraoperative and postoperative monitoring, and urgent management of potentially reversible compressive causes of vision loss can improve outcomes.
Collapse
Affiliation(s)
- Prerana Kansakar
- Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore.,Department of Ophthalmology, Grande International Hospital, Kathmandu, Nepal
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore
| |
Collapse
|
34
|
Improved Outcomes of Orbital Reconstruction With Intraoperative Imaging and Rapid Prototyping. J Oral Maxillofac Surg 2019; 77:1211-1217. [DOI: 10.1016/j.joms.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/22/2022]
|
35
|
Abstract
BACKGROUND Although the eye is a well-protected organ, it is frequently affected by trauma. The timely detection of ocular injuries is extremely important. In this study, the authors evaluated the consistency between findings in computed tomography (CT) examination for orbital fractures and globe integrity and clinical findings in patients presenting to the emergency department due to orbital trauma. METHODS The authors retrospectively reviewed the files of patients presenting with orbital trauma between January 2015 and January 2018 from emergency department records. Ophthalmology consultation and follow-up notes, radiology reports, and the emergency physician's notes were reviewed. RESULTS During the study period, 286 patients presented to the emergency department with orbital trauma. A total of 119 eyes of 83 patients who underwent orbital CT were included in the study. Orbital bone fracture was detected in 54.6% (n = 65) of the eyes. Of these, 73.8% (n = 48) involved multiple fractures. Among all eyes, the distribution of fractures in the orbital walls was lateral wall in 41.2% (n = 49), floor in 32.8% (n = 39), medial wall in 31.1% (n = 37), and roof in 10.9% (n = 13). Multiple wall fractures were detected in 36.9% (n = 44) of the eyes. At least 1 clinical finding such as diplopia, laceration, abnormal pupillary response, hypoesthesia, and exophthalmos was observed in 47.1% (n = 56) of the eyes. This rate was 56.8% among eyes with orbital fractures and 35.2% in those without fracture. There was a statistically significant relationship between floor fractures and diplopia (P = 0.002). No significant correlations were found between the other radiological and clinical findings. CONCLUSION Our study revealed a relationship between the presence of orbital fracture and eye damage. In particular, the authors found that the frequency of diplopia was significantly higher in eyes with maxillary bone fracture in the orbital floor. However, orbital CT findings other than bone fracture were not consistent with clinical findings.
Collapse
|
36
|
Craen A, Ganti L. Orbital floor fracture with periorbital haematoma. BMJ Case Rep 2019; 12:12/2/bcr-2018-227719. [DOI: 10.1136/bcr-2018-227719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Jelenković B, Nikolov V, Živković S, Berilažić L, Milošević P. OPEN COMMINUTED EXPRESSED - DEPRESSED SKULL FRACTURE. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
38
|
Relationship Between Nasal Fracture and Blowout Fracture: Can Nasal Fracture Be a Predictor of Blowout Fracture? J Oral Maxillofac Surg 2018; 77:1433.e1-1433.e6. [PMID: 30308146 DOI: 10.1016/j.joms.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Nasal and blowout fractures are the most common injuries from craniomaxillofacial trauma. Nasal fractures are easily diagnosed by clinical signs, such as pain and crepitus. However, blowout fractures are frequently asymptomatic and are easy to miss without computed tomographic (CT) scanning. This study analyzed the relation between the 2 fracture types to determine whether nasal fracture could be used as a predictor of blowout fracture. MATERIALS AND METHODS CT scans of 1,368 patients who underwent reduction surgery for nasal fracture were retrospectively reviewed. The pattern of nasal fractures (n = 1,368) was classified as frontal or lateral according to the direction of impact. Blowout fractures (n = 297) were classified into 3 types according to the position of the fracture: medial, inferior, or inferomedial wall. After calculating the number of patients in each group, the relation between nasal and blowout fracture types was statistically analyzed. RESULTS Of 305 patients with frontal-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 26, 7, and 9, respectively. Of 1,063 patients with lateral-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 118, 75, and 62, respectively. Medial wall fracture was most common in the 2 nasal fracture groups and showed a higher frequency in the lateral-type group. CONCLUSIONS This study showed a strong relation between nasal fractures and medial wall blowout fractures. If nasal fracture is suspected, especially the lateral type, then thorough examination for medial wall blowout fracture, with a high index of suspicion, should be performed.
Collapse
|
39
|
Seo BF, Kang KJ, Jung SN, Byeon JH. Skeletal cavernous hemangiomas of the frontal bone with orbital roof and rim involvement. Arch Craniofac Surg 2018; 19:214-217. [PMID: 30282433 PMCID: PMC6177681 DOI: 10.7181/acfs.2018.01921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022] Open
Abstract
Skeletal cavernous hemangiomas are rare, benign tumors that may involve the supraorbital rim and orbital roof. However, such involvement is extremely rare. We report a case of skeletal cavernous hemangioma of the frontal bone involving the orbital roof and rim. En bloc excision and reconstruction, using a calvarial bone graft for the orbital roof and rim defect, was performed. It is important not only to perform total excision of skeletal cavernous hemangiomas, but to properly reconstruct the defects after the total excision since several complications can arise from an orbital roof and rim defect.
Collapse
Affiliation(s)
- Bommie Florence Seo
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyo Joon Kang
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sung-No Jung
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jun Hee Byeon
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| |
Collapse
|
40
|
Chen CH, Chen CT, Wang PF, Wang YT, Hsu PH, Lin CL. A novel anatomical thin titanium mesh plate with patient-matched bending technique for orbital floor reconstruction. J Craniomaxillofac Surg 2018; 46:1526-1532. [PMID: 30001884 DOI: 10.1016/j.jcms.2018.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022] Open
Abstract
This study developed an anatomical thin titanium mesh (ATTM) plate for Asian orbital floor fracture based on the medical image database. The computer aided stamping analysis was performed on four hole/slot patterns included the control type without hole design, circular hole pattern, slot pattern and hole/slot hybrid patterns within the ATTM plate with upper/lower dies of averaged orbital cavity reconstruction models. The curved-fan ATTM plate with 0.4 mm thickness was manufactured and pre-bent using a patient matched stamping process to verify its feasibility and the interfacial fitness between the plate and bone on the orbital floor fracture model. The stamping analysis found that the hole/slot hybrid patterns design resulted in the most favorable performance among all designs owing to the lowest maximum von-Mises stress/strain and spring-back value. The interfacial adaption results test showed that the average patient-matched stamping bending gap size was only 0.821 mm and the operative time was about 8 s. This study concluded that the curved-fan ATTM plate with hole/slot hybrid pattern design and patient-matched pre-bent technique can fit the ATTM plate/orbital cavity interface well, decrease unstable fracture segment mobility and improve the overall reduction efficiency.
Collapse
Affiliation(s)
- Chih-Hao Chen
- Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Keelung, Taiwan; Chang Gung University, College of Medicine, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan.
| | - Chien-Tzung Chen
- Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Keelung, Taiwan; Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kueishan, Keelung, Taoyuan, 333, Taiwan.
| | - Po-Fang Wang
- Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kueishan, Keelung, Taoyuan, 333, Taiwan.
| | - Yu-Tzu Wang
- Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
| | - Pin-Hsin Hsu
- Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
| |
Collapse
|
41
|
|
42
|
Medial Orbital Wall Reconstruction With Porous Polyethylene by Using a Transconjunctival Approach With a Caruncular Extension. Ann Plast Surg 2017; 78:S89-S94. [PMID: 28195890 DOI: 10.1097/sap.0000000000001012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The reported rate of isolated medial orbital wall fractures varies widely but has been found to be as high as 55% of all orbital fractures. Identifying and repairing medial orbital wall defects by using appropriate materials improves patient outcome considerably; however, most related research has focused on orbital floor defect management rather than medial orbital wall treatment, and no consensus on repairing medial orbital wall fractures exists. Furthermore, medial orbital wall fracture is a main cause of posttraumatic enophthalmos. In this study, we introduce a modified surgical technique for repairing large medial wall fractures stably, also reviewed relevant literature and established an algorithm for managing medial orbital wall fractures. METHODS We reviewed the outcomes of facial trauma patients who underwent facial bone reduction and internal fixation surgery in our hospital between October 1, 2010, and October 1, 2013. The patients were all treated medial orbital wall reconstruction with porous polyethylene by using a transconjunctival approach with a caruncular extension for large medial orbital wall fractures. Medical records and radiologic images of the patients were reviewed retrospectively. The outcomes evaluated were trauma mechanism, clinical findings of ocular injury, preoperative and postoperative ocular symptoms, degree of enophthalmos, and orbital volume restoration after surgery. RESULTS Transconjunctival approach with a caruncular extension was performed without any complications. The incidence of diplopia was 47.4% and enophthalmos (>2 mm) was 31.6%, with no significant diplopia and enophthalmos after surgery. Patients were symptom-free on follow-up. The average enophthalmos was successfully corrected from 0.88 mm preoperatively to 0.26 mm and orbital volume was corrected from 26.22 to 22.99 cm after surgery; these results also showed P less than 0.001. CONCLUSIONS The current results suggest that the proposed method of medial orbital wall reconstruction, in which porous polyethylene is implanted by using a transconjunctival approach with a caruncular extension, yields favorable outcomes. The approach facilitates a wide visualization of the operative field, which provides sufficient working space for implant insertion and is consequently free from iatrogenic trauma or surgery-related complications.
Collapse
|
43
|
Runci M, De Ponte FS, Falzea R, Bramanti E, Lauritano F, Cervino G, Famà F, Calvo A, Crimi S, Rapisarda S, Cicciù M. Facial and Orbital Fractures: A Fifteen Years Retrospective Evaluation of North East Sicily Treated Patients. Open Dent J 2017; 11:546-556. [PMID: 29238415 PMCID: PMC5712659 DOI: 10.2174/1874210601711010546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/22/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Orbital fractures are classified as diseases usually related to common midface trauma. It represents the most challenging treatment due to the complex anatomy, physiology, and aesthetic role. A midface trauma involves also the zygomatic complex and the nose, however the orbit fracture seems to be a more frequent disease due to its anatomical features. Objective: The purpose of this work is to retrospectively evaluate and record the frequency of the midfacial traumas and orbital fractures observed in the North Eastern Sicily. The results of the present data may be useful for the clinicians in order to recognize the kind of fracture just from the first general visit having a quick diagnosis and management. Methods: In the years between 2001 and 2016, about 1200 patients with midfacial trauma and about 100 patients involving the orbital floor have been evaluated. All those patients underwent the surgical fracture reduction and a CT scan follow up control at one month, three months, six months and one year. Results: Data showed high percentage of orbital floor, nose and mandibular body and ramus fractures; moreover the most frequent causes of fractures seem to be related to motor vehicle accident, followed by assaults, work and fall. Conclusion: The results have highlighted the changing trends in the causes of facial injuries, particularly the increasing incidence of assaults and the falling incidence of motor vehicle accidents in developed countries. The quick diagnosis and management proved fundamental for the successful treatment. Clinicians should be able to recognize the first symptoms in order to avoid possible complications.
Collapse
Affiliation(s)
- Michele Runci
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Francesco Saverio De Ponte
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Roberto Falzea
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Ennio Bramanti
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Floriana Lauritano
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Gabriele Cervino
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Fausto Famà
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Alessandro Calvo
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Salvatore Crimi
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Silvia Rapisarda
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| | - Marco Cicciù
- Department of Biomedical, Dental Science and Morphological and Functional Images, Dental School, University of Messina, Messina, Italy
| |
Collapse
|
44
|
Postoperative CT of the Midfacial Skeleton After Trauma: Review of Normal Appearances and Common Complications. AJR Am J Roentgenol 2017; 209:W238-W248. [PMID: 28705063 DOI: 10.2214/ajr.17.17875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this article is to describe the CT appearance of the midfacial skeleton after surgical repair of posttraumatic Le Fort, nasoorbitoethmoidal (NOE), and frontal sinus fractures. Several of the more commonly encountered complications will also be described. CONCLUSION Surgery after midfacial trauma is aimed at restoring both form and function. Knowledge of the principal tenets of Le Fort, NOE, and frontal sinus fracture repair is vital for radiologists to accurately assess the adequacy of treatment on postoperative CT and provide meaningful reports for the surgeon.
Collapse
|
45
|
Mohapatra DP, Thiruvoth FM, Chittoria RK, Kumar SD, Kumar SH, Kumar S, Babu P, Kumar E. Proposal of a new classification scheme for periocular injuries. Indian J Plast Surg 2017; 50:21-28. [PMID: 28615806 PMCID: PMC5469230 DOI: 10.4103/ijps.ijps_207_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. Material and Methods: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. Results: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. Discussion: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. Conclusion: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.
Collapse
Affiliation(s)
- Devi Prasad Mohapatra
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Friji Meethale Thiruvoth
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ravi Kumar Chittoria
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - S Dinesh Kumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Sudhanva Hemant Kumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Senthil Kumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Preethitha Babu
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Elan Kumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
46
|
Hosokawa S, Suzuki K, Hakamada K, Hayashi Y, Mineta H. Fallen eyeball injury. Braz J Otorhinolaryngol 2017; 86 Suppl 1:35-37. [PMID: 28559145 PMCID: PMC9422731 DOI: 10.1016/j.bjorl.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/10/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Seiji Hosokawa
- Hamamatsu University School of Medicine, Department of Otorhinolaryngology Head & Neck Surgery, Hamamatsu, Japan.
| | - Katsuyoshi Suzuki
- Seirei Hamamatsu General Hospital, Department of Otorhinolaryngology, Hamamatsu, Japan
| | - Katsura Hakamada
- Seirei Hamamatsu General Hospital, Department of Otorhinolaryngology, Hamamatsu, Japan
| | - Yasuhiro Hayashi
- Seirei Yokohama General Hospital, Department of Otorhinolaryngology, Yokohama, Japan
| | - Hiroyuki Mineta
- Hamamatsu University School of Medicine, Department of Otorhinolaryngology Head & Neck Surgery, Hamamatsu, Japan
| |
Collapse
|
47
|
Kim YC, Jeong WS, Park TK, Choi JW, Koh KS, Oh TS. The accuracy of patient specific implant prebented with 3D-printed rapid prototype model for orbital wall reconstruction. J Craniomaxillofac Surg 2017; 45:928-936. [DOI: 10.1016/j.jcms.2017.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 11/15/2022] Open
|
48
|
Yang DJ, Kim YJ, Seo DW, Lee HJ, Park IJ, Sohn CH, Ryoo JM, Lee JS, Kim WY, Lim KS. Characteristics of orbital wall fractures in preschool and school-aged children. Clin Exp Emerg Med 2017; 4:32-37. [PMID: 28435900 PMCID: PMC5385511 DOI: 10.15441/ceem.16.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/28/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate the injury patterns in pediatric patients with an orbital wall fracture (OWF) and to identify the differences in injury patterns between preschool and school-aged patients with OWF who presented to the emergency department. Methods We performed a retrospective observational study in the emergency department of a tertiary hospital between January 2004 and March 2014. A total of 177 pediatric patients (<18 years) with OWF who underwent facial bone computed tomography scans with specific discharge codes were included. Patients were categorized into preschool (≤7 years) and school-aged (>7 years) pediatric groups. Results The inferior wall was the most common fracture site in both the preschool and school-aged pediatric groups (50.0% vs. 64.4%, P=0.15). The male-to-female ratio and the mechanism of injury showed significant differences between the two age groups. Violence was the most common mechanism of injury in the school-aged pediatric group (49.3%), whereas falls from a height caused OWF in approximately half of the patients in the preschool pediatric group (42.9%). Concomitant injuries and facial fractures had a tendency to occur more frequently in the school-aged pediatric group. Conclusion Significant differences according to the sex and mechanisms of injury were identified in preschool and school-aged pediatric patients with OWF.
Collapse
Affiliation(s)
- Dong Jin Yang
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Joo Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-June Park
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Min Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
49
|
Zieliński R, Malińska M, Kozakiewicz M. Classical versus custom orbital wall reconstruction: Selected factors regarding surgery and hospitalization. J Craniomaxillofac Surg 2017; 45:710-715. [PMID: 28318927 DOI: 10.1016/j.jcms.2017.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/04/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Nowadays, in orbital wall reconstruction, maxillofacial surgeons have the possibility to treat patients in modern ways such as with individual implants. Nevertheless, conventional treatment including standard titanium mesh shaped during the surgical procedure is also widely used. The aim of this study was to compare the above methods of orbital wall reconstructions. MATERIALS AND METHODS In the first group (39 cases), patients were treated by means of computer-aided design/computer-aided manufacturing (CAD/CAM) milled individual implants made of ultra-high-molecular-weight polyethylene, dioxide zirconium and rapid prototyping titanium mesh pre-bent on an ABS model made by a three-dimensional (3D) printer. In the second group (54 cases), intraoperative bending of titanium mesh was implemented. RESULTS Ophthalmologic outcomes were the same in both groups. In patients who had greater destruction of the orbit, surgical procedures were longer regardless of the material used for individual implants (p < 0.05). Time of surgery was shorter in patients in whom individual implants were used. Intraoperative bleeding was higher in patients who were treated using intraoperative bending titanium mesh (p < 0.01). CONCLUSION Application of CAD/CAM techniques do not give better ophthalmologic results in reference center but improve patient condition postoperatively. For this reason, CAD/CAM is a safer treatment method for patients.
Collapse
Affiliation(s)
- Rafał Zieliński
- Department of Maxillofacial Surgery (Head: Prof. Marcin Kozakiewicz, DDS), Medical University of Lodz, 1st Haller pl., 90-647 Lodz, Poland.
| | | | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery (Head: Prof. Marcin Kozakiewicz, DDS), Medical University of Lodz, 1st Haller pl., 90-647 Lodz, Poland
| |
Collapse
|
50
|
Lichtenstein JT, Zeller AN, Lemound J, Lichtenstein TE, Rana M, Gellrich NC, Wagner ME. 3D-Printed Simulation Device for Orbital Surgery. JOURNAL OF SURGICAL EDUCATION 2017; 74:2-8. [PMID: 27986443 DOI: 10.1016/j.jsurg.2016.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/16/2016] [Accepted: 07/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Orbital surgery is a challenging procedure because of its complex anatomy. Training could especially benefit from dedicated study models. The currently available devices lack sufficient anatomical representation and realistic soft tissue properties. Hence, we developed a 3D-printed simulation device for orbital surgery with tactual (haptic) correct simulation of all relevant anatomical structures. DESIGN, SETTING, AND PARTICIPANTS Based on computed tomography scans collected from patients treated in a third referral center, the hard and soft tissue were segmented and virtually processed to generate a 3D-model of the orbit. Hard tissue was then physically realized by 3D-printing. The soft tissue was manufactured by a composite silicone model of the nucleus and the surrounding tissue over a negative mold model also generated by 3D-printing. The final model was evaluated by a group of 5 trainees in oral and maxillofacial surgery (1) and a group of 5 consultants (2). All participants were asked to reconstruct an isolated orbital floor defect with a titanium implant. A stereotactic navigation system was available to all participants. Their experience was evaluated for haptic realism, correct representation of surgical approach, general handling of model, insertion of implant into the orbit, placement and fixation of implant, and usability of navigated control. The items were evaluated via nonparametric statistics (1 [poor]-5 [good]). RESULTS Group 1 gave an average mark of 4.0 (±0.9) versus 4.6 (±0.6) by group 2. The haptics were rated as 3.6 (±1.1) [1] and 4.2 (±0.8) [2]. The surgical approach was graded 3.7 (±1.2) [1] and 4.0 (±1.0) [2]. Handling of the models was rated 3.5 (±1.1) [1] and 4 (±0.7) [2]. The insertion of the implants was marked as 3.7 (±0.8) [1] and 4.2 (±0.8) [2]. Fixation of the implants was also perceived to be realistic with 3.6 (±0.9) [1] and 4.2 (±0.45) [2]. Lastly, surgical navigation was rated 3.8 (±0.8) [1] and 4.6 (±0.56) [2]. CONCLUSION In this project, all relevant hard and soft tissue characteristics of orbital anatomy could be realized. Moreover, it was possible to demonstrate that the entire workflow of an orbital procedure may be simulated. Hence, using this model training expenses may be reduced and patient security could be enhanced.
Collapse
Affiliation(s)
- Juergen Thomas Lichtenstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
| | | | - Juliana Lemound
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | | | - Majeed Rana
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Eberhard Wagner
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|