PurposeTo study the advantages of using Computer‐Aided Design (CAD)/Computer‐Aided Manufacturing (CAM) technologies in the treatment of Graves Orbitopathy (GO).MethodsResearch analysis of contemporary scientific medical publications on the subject, The 2018 European Group on Graves ‘Orbitopathy Guidelines for the Management of Graves’ Orbitopathy (EUGOGO), Philips Diamond Select Brilliance CT64, software environment Sim Plant 13.02 and Geomagic Freeform Plus.ResultsGraves Orbitopathy (GO) is an autoimmune disease that results in dysteroid optic neuropathy (DON) in 3–5% of patients and progressive vision loss. According to the recommendations of EUGOGO 2018, orbital decompression is performed at the first stage of surgical treatment as scheduled with moderate inactive GO or immediately in patients with DON and/or rupture of the cornea with the involvement of a multidisciplinary team of radiodiagnosis, endocrinologist, ophthalmologist and maxillofacial surgeon. To increase the volume of bone orbit, surgeons extend the medial, lateral walls of the orbit, or the floor of the orbit, and remove a certain amount of infraorbital fat, but the only correct approach to date has not been determined (EUGOGO 2016). Given the need for an individual approach to the patient, the use of CAD/CAM technology to obtain three‐dimensional models of the skull expands the ability to study the features of the anatomy of the walls of the orbit, its volume, planning of surgery.ConclusionsThe result of a carefully planned orbit decompression using CAD/CAM technology is not only the reduction of intraocular pressure and exophthalmos for optimal treatment, but also the reduction of intraoperative complications (traumatization of the neurovascular bundles, muscles, etc.), shortening the duration of surgery.

Нові підходи до екзопротезування орбіти з використанням СAD/CAM-технологій Резюме. Косметичне протезування пацієнтів після проведеної екзентерації орбіти залишається актуальною проблемою офтальмології й щелепно-лицевої хірургії. Процес екзопротезування орбіти досить складний і вимагає міждисциплінарного підходу із залученням біоінженера, окуляриста, офтальмолога й щелепно-лицевого хірурга. Кінцевий результат має задовольняти в першу чергу пацієнта, для якого анофтальм стає не лише медичною, а й психологічною і соціальною проблемою, що ускладнює стосунки з людьми вдома та на роботі. У роботі наведено клінічний випадок екзопротезування орбіти з використанням комп'ютерних СAD/СAM-технологій у 33-річної пацієнтки, якій у 2-річному віці виконано екзентерацію правої орбіти з приводу саркоми. Лікування проводилося в декілька етапів: сегментація даних комп'ютерної томографії та створення віртуальних тривимірних комп'ютерних моделей; створення дизайну пацієнтспецифічних імплантатів як основи для фіксації екзопротеза; оперативне втручанняфіксація пацієнтспецифічних імплантатів; виготовлення екзопротеза. Післяопераційний період пройшов без ускладнень. Через півроку після остеоінтеграції титанових імплантів виготовлений екзопротез поміщено в ложе та забезпечено умови для його постійної фіксації. Результати проведеного лікування повністю задовольнили естетичні вимоги пацієнтки, що дозволило їй вільно спілкуватися з людьми і повернутися до повноцінного життя.

Background. This article highlights the main approaches to the treatment of patients with endocrine orbitopathy (EO) and current opportunities for planning and conducting personalized orbital decompression, including the use of Computer-Aided Design (CAD) / Computer-Aided Manufacturing (CAM) technologies. Optimization of treatment of this pathology which can lead to changes in appearance, inability to perform usual work, social isolation, and in the most difficult cases to vision loss is a topical issue of ophthalmology and maxillofacial surgery. The aim. To analyze current information on basic approaches to the treatment of patients with endocrine orbitopathy and the possibility of using computer technologies for planning and performing personalized orbital decompression. Results. The use of corticosteroids, radiation therapy, surgical treatment are the key methods used to manage patients with EO. The use of CAD/CAM technologies allows to plan surgery according to the morphological features of the orbit of each patient. This can potentially affect the outcome of decompression and reduction of exophthalmos, as well as intraoperative complications. When using standard approaches, the results of decompression may vary significantly due to the differences in morphological parameters of the orbits. This dictates the need for a personalized approach to the management of patients with EO. Due to the significant variability of morphological parameters of the orbits in the case of standard approaches, the results in different patients can differ significantly, which dictates the need for a personalized approach to the management of patients with EA. Conclusions. EUGOGO 2016 recommends a multidisciplinary step-by-step approach to the management of patients with EO, depending on its activity and severity and the impact on the patient’s quality of life. A personalized approach using computer simulations and the development of surgical navigation templates for surgical decompression of the orbit will ensure optimal functional and aesthetic treatment results. Keywords: endocrine orbitopathy, treatment, orbital decompression, ComputerAided Design (CAD) / Computer-Aided Manufacturing (CAM) technologies, personalized approach.

PurposeTo study the advantages and disadvantages of using CAD/CAM technologies in the treatment of endocrine orbitopathy.MethodsResearch analysis of modern scientific publications, Sim Plant 13.02 software environment and Geomagic Freeform Plus.ResultsAccording to the literature, the frequency of complications of surgical decompression of the orbit is from 9.3% to 35% (most often ‐ the appearance of secondary diplopia, less often ‐ lesions of the hyoid nerve, cerebrospinal fluid leakage, epistaxis, bleeding in the orbit, etc. [Leong, 2009, Sellari‐Franceschini, 2016]. As patients today expect excellent functional and aesthetic results of surgical treatment, the urgent problem is to find new opportunities for planning and performing surgical decompression of the orbit, including the use of Computer‐Aided Design (CAD)/Computer‐Aided Manufacturing (CAM) technologies. Given the need for an individualized approach to the patient, the use of CAD/CAM technology in the treatment of endocrine orbitopathy has a number of advantages: obtaining three‐dimensional models of the skull expands the study of anatomy of the orbital walls, its volume, exophthalmos and minimization of intraoperative complications. The disadvantages of using CAD/CAM technologies are the multi‐stage and time‐consuming process (multislice computed tomography and data export to the software environment, segmentation of anatomical objects and creation of virtual three‐dimensional models, printing of resection surgical templates by stereolithography) and high cost.ConclusionsThe use of CAD/CAM technologies to optimize surgical decompression of the orbit in patients with endocrine orbitopathy has a number of advantages and disadvantages.

Introduction Restoration of the volume of the orbit and its integrity, elimination of aesthetic and functional complications in patients with defects in the walls of the orbit remains an urgent problem of ophthalmology and maxillofacial surgery. Purpose To evaluate the results of surgical treatment of patients with defects in orbital walls using individually‐made implants using 3D modeling based on CT data. Methods CT Toshiba Activion 16, CT Philips Diamond Select Brilliance CT 64, software environment Sim Plant 13.02 and Geomagic Freeform Plus, statistical data processing. Results After treatment of patients with orbital bone defects using individually‐made implants using computer 3D modeling based on CT data, the mean difference in orbital volume was 2.7 ± 0.9 cm3. Conclusion The use of computer 3D modeling in the manufacture of individual implants for the treatment of patients with defects in the orbital walls increases the accuracy of the recovery of the orbital volume, and, accordingly, minimizes the number of postoperative complications.