Late reconstruction of post-traumatic enophthalmos and hypoglobus using three-dimensional implants: a case series

Abstract

Post-traumatic enophthalmos and hypoglobus are common sequelae of facial bone fractures, even after reduction surgery. They are associated with functional and esthetic issues, which may lower the quality of life. These deformities frequently present late, and adequate correction is difficult. We report three cases of late inferior orbital rim reconstructions with three-dimensional printed implants to help resolve these problems. The average duration between the traumatic event and surgery was 3 years and 4 months. One patient was treated with a completely absorbable implant and exhibited satisfactory results until the implant started to biodegrade at 1 year and 9 months after surgery. Two patients were treated with a permanent implant and demonstrated satisfactory results. However, longer follow-up periods were needed. There were no complications such as infection, diplopia, or restriction of ocular motion and the patients were satisfied with the esthetic results.

Towards Precision Ophthalmology: The Role of 3D Printing and Bioprinting in Oculoplastic Surgery, Retinal, Corneal, and Glaucoma Treatment

“…Current investigations into 3D printing technology explore its viability for crafting personalized orbital implants, with a significant body of research focusing on utilizing 3D models for implant customization [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] and for the creation of directly printed implants [ 45 , 46 , 47 , 48 , 49 , 50 ]. Chai et al (2021) demonstrated the efficacy of using patient-specific 3D-printed models as templates for intraoperative adjustments to implants, noting a marked decrease in both surgery duration and related complications [ 32 ].…”

“…In summary, 3D printing provides several benefits in terms of accuracy and surgical outcomes ( Table 2 ), with most orbital implant guides made of titanium [ 35 , 36 , 37 , 38 , 39 ] and direct models made of polycaprolactone [ 45 , 46 , 47 ]. Nonetheless, several gaps remain.…”

“…et al (2019) demonstrated adequate postoperative results, mitigating infection or inflammatory response while maintaining functional outcomes [46]. Choi et al (2022) applied direct printing as an option for aesthetic reconstruction in patients with previous facial fractures presenting with late enophthalmos and hypoglobus, demonstrating the possible benefits of 3D implants in postoperative care [47].…”

The Use of Functional Biomaterials in Aesthetic and Functional Restoration in Orbital Surgery

“…This method leverages the mirroring of an unaffected orbit's anatomy over the damaged one to generate a preformed mesh. Transitioning from these conceptual frameworks, contemporary research has delved into the practicalities of personalized orbital implants, predominantly focusing on the role of 3D models for implant shaping and direct 3D-printed implants [35][36][37][38][39][40]. Chai et al (2021) used 3D-printed models of patient fractures as templates in intraoperative implant trimming [41], demonstrating a significant reduction in surgical time and complications.…”

Current concepts of craniofacial fibrous dysplasia: pathophysiology and treatment

“…Advanced imaging techniques and three-dimensional analyses of scans, together with virtual surgical planning for subtotal excision or complete excision of the lesion and reconstruction with autologous tissue or implants made by computer-aided manufacturing and patient-specific design, should be regarded as the standard of care in surgery for FD of the craniofacial skeleton [ 38 , 39 ]. Simple curettage is not recommended as a primary option, as it is ineffective and may increase the risk of complications [ 40 – 42 ].…”