Orbital Wall Reconstruction with Two-Piece Puzzle 3D Printed Implants: Technical Note

Abstract

The purpose of this article is to describe a technique for secondary reconstruction of traumatic orbital wall defects using titanium implants that act as three-dimensional (3D) puzzle pieces. We present three cases of large defect reconstruction using implants produced by Xilloc Medical B.V. (Maastricht, the Netherlands) with a 3D printer manufactured by LayerWise (3D Systems; Heverlee, Belgium), and designed using the biomedical engineering software programs ProPlan and 3-Matic (Materialise, Heverlee, Belgium). The smaller size of the implants allowed sequential implantation for the reconstruction of extensive two-wall defects via a limited transconjunctival incision. The precise fit of the implants with regard to the surrounding ledges and each other was confirmed by intraoperative 3D imaging (Mobile C-arm Systems B.V. Pulsera, Philips Medical Systems, Eindhoven, the Netherlands). The patients showed near-complete restoration of orbital volume and ocular motility. However, challenges remain, including traumatic fat atrophy and fibrosis.

Guidelines for patient-specific jawline definition with titanium implants in esthetic, deformity, and malformation surgery

“…[10] The use of one or two 3D puzzle connections does not make a difference in the author's experience [Figure 2]. However, an oversized 3D design may hamper insertion of the second segment because more lateral soft tissue stretch is required [Figure 3].…”

Patient-specific two-piece screwless implant for the reconstruction of a large orbital fracture

“…Two-piece implants for the reconstruction of orbital fractures have been described previously. 3,4 We present a design for, and describe the implantation of, a customised screwless and interlocking two-piece orbital implant for the reconstruction of a large orbital fracture.…”

“…In extensive orbital fractures, the required size of the implant need not necessarily dictate the size of the incision required. Combining the benefits of a screwless custom-made orbital implant 5 with interlocking multipiece construction 3,4 can produce excellent results regarding both functionality and aesthetics. Accurate anatomical design of the milled titanium implant ensures a precise fit in the orbit (Fig.…”

Reconstruction of Post-Traumatic Orbital Defects and Deformities with Custom-Made Patient-Specific Implants: Evaluation of the Efficacy and Clinical Outcome

“…It complicates social adaptation of the patients, and affects the psychological state. [1][2][3] Traditional methods for restoration of the orbital volume and anatomic shape include the usage of standard preformed titanium plates and meshes available in different sizes, polymeric implants of thin polyethylene membranes, and autologous bone grafts. 1,4 Bone grafts and standard titanium or polymeric implants usually require prebending or intraoperative bending and correction of the contours.…”

“…The proper insertion and positioning of the implants or grafts inside the orbit, especially in the region of the orbital ledge, remain challenging. 3,5 The problem could be solved with digital intraoperative navigation systems, but the high cost of the equipment limits their use. Moreover, these systems do not ensure a precise fit of the bone graft or implant if their geometry does not match the contours of the defect or individual orbital shape.…”