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. 2013 Jul 2:9:18.
doi: 10.1186/1746-160X-9-18.

Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study

Harald Essig, Lars Dressel, Majeed Rana, Madiha Rana, Horst Kokemueller, Martin Ruecker, Nils-Claudius Gellrich

Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study

Harald Essig et al. Head Face Med. .

Abstract

Background: The aim of orbital wall reconstruction is to reestablish anatomically exact orbital volumes to avoid long-term complications. Navigation could facilitate complex reconstructions.

Methods: Quality of the orbital reconstruction (n=94) was measured based on (A) volume changes and (B) on 3D shape deviations compared to the unaffected side. Volume analysis included segmentation of the orbital cavity in the pre- and post-operative 3D data set (VoXim®, IVS Solutions, Germany), and shape analysis was performed by vector-based 3D tools (Comparison®, 3Dshape, Germany).

Results: Orbital volume of the unaffected side ranged from 26.6 ml±2.8 ml in male and 25.2 ml±2.6 ml in female (CT). Significant orbital enlargement was found in orbital fractures with involvement of the posterior third of the orbital floor and in comminuted fracture pattern. Reconstructed orbital volume ranged from 26.9±2.7 ml in male and 24.26±2.5 ml in female (CBCT). 3D Analysis of the color mapping showed minor deviations compared to the mirrored unaffected side.

Conclusion: Measurements demonstrate that even in comminuted orbital fractures true-to-original reconstruction is feasible.

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Figures

Figure 1
Figure 1
Image analysis in sagittal view (A) and coronal view (B), (C) pre-operative segmentation (CT scan), (D) both virtual segments, (E) intra-operative Navigation-assisted surgery using VoXim®, (F) post-operative control (CBCT-scan).
Figure 2
Figure 2
Segmentation of (A) unaffected, (B) affected, and (C) reconstructed orbit.
Figure 3
Figure 3
3D shape analysis. (A) Manually superimposed pre- and post-operative virtual models – before matching procedure. (B) after matching procedure. (C) typical segmentation of a titanium mesh implant. (D) medial orbital wall as area of interest (green signifies no differences compared to the virtual planning). (E) orbital floor with transition zone to the medial wall (in red; differences are up to 1.5 mm). (F) complete titanium mesh implant shows an excellent result.
Figure 4
Figure 4
Orbital volume in adults (gender dependent).
Figure 5
Figure 5
Comparison imaging modality (CT versus CBCT).
Figure 6
Figure 6
Comparison of Navigation-assisted surgery versus conventional surgery (fract) fractured orbit, CT, (unaffected) unaffected orbit, CBCT, (reco) reconstructed orbit, CBCT.
Figure 7
Figure 7
Analyzed anatomical regions (group Navi) (a) anterior third, (c) central third, (p) posterior third of the orbital wall.
Figure 8
Figure 8
Deviation of reconstruction.
See this image and copyright information in PMC

References

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