Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models

Abstract

The present study aimed to analyze if a preformed “hybrid” patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture’s shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called “hybrid” patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when “hybrid” patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery’s timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.

Surgical Treatment of Blow-out Fracture: A New Perspective

“…Although the surgical options for orbital fractures are still controversially discussed, it is known that a high rate of postoperative complications is still found today 1. A retrospective review analyzed 1594 patients between 2007 and 2017 and found a complication rate of 18%, which is within the range found in the literature in general 1,2. These data highlight the need to implement techniques to improve patient planning and treatment.…”

“…Orbital blow-out fractures occur when there is herniation of the infraorbital fat into the maxillary sinus or the region of the ethmoid cells due to the collapse of the floor or medial wall of the orbit 1. Such defects usually generate ophthalmoplegia, enophthalmia, dystopia, and diplopia; therefore, they require a thorough and assertive surgical repair to reconstruct the orbital anatomy 1,2.…”

“…Orbital blow-out fractures occur when there is herniation of the infraorbital fat into the maxillary sinus or the region of the ethmoid cells due to the collapse of the floor or medial wall of the orbit 1. Such defects usually generate ophthalmoplegia, enophthalmia, dystopia, and diplopia; therefore, they require a thorough and assertive surgical repair to reconstruct the orbital anatomy 1,2. Computed tomography (CT) is already established as an essential diagnostic test to determine the extent of the fracture, but it has gained more importance through the use of 3D technology for better planning and with the possibility of using it at the time of surgery to confirm the proper positioning of the orbital reconstruction plate, thus allowing any necessary modification during the operation 3,4.…”

Primary Orbital Reconstruction with Selective Laser Melting (SLM) of Patient-Specific Implants (PSIs): An Overview of 96 Surgically Treated Patients

“…Particularly concerning accuracy during orbital reconstruction, computer-assisted surgery with preoperative planning helps to guide surgeons during surgery [ 24 ]. Furthermore, pre-bent implants using 3D-printed orbital anatomical models have been shown to provide a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant [ 25 ].…”

Distance mapping in three-dimensional virtual surgical planning in hand, wrist and forearm surgery: a tool to avoid mistakes

“…Virtual planning of surgical interventions and implant preparation enhances the confidence of the surgeon, reduces time in the operating room and can improve the functional outcome [ 1 ]. Since the first description of its use in corrective osteotomies of the distal radius in the late 1980s, three-dimensional (3D) virtual surgical planning (VSP) has become popular, particularly with the introduction of certified medical surgical planning software (Mimics, Materialise, Leuven, Belgium; Rhino Medical, Rhino Medical Services, Arlington, Texas, USA) [ 2 – 5 ].…”