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Review
. 2019 Sep;18(3):329-338.
doi: 10.1007/s12663-019-01207-y. Epub 2019 Mar 21.

Navigation-Assisted Orbital Trauma Reconstruction Using a Bioactive Osteoconductive/Bioresorbable u-HA/PLLA System

Affiliations
Review

Navigation-Assisted Orbital Trauma Reconstruction Using a Bioactive Osteoconductive/Bioresorbable u-HA/PLLA System

Takahiro Kanno et al. J Maxillofac Oral Surg. 2019 Sep.

Abstract

Orbital fractures with orbital wall defects are common facial fractures encountered by oral-maxillofacial surgeons, because of the exposed position and thin bony walls of the midface. The primary goal of surgery is to restore the pre-injury anatomy and volume of hard tissue, and to free incarcerated or prolapsed orbital tissue from the fracture by bridging the bony defects with reconstructive implant material and restoring the maxillofacial-orbital skeleton. Numerous studies have reported orbital fracture repair with a wide variety of implant materials that offer various advantages and disadvantages. The ideal orbital implant material will allow conformation to individual patients' anatomical characteristics, remain stable over time, and are radiopaque, especially for the reconstruction of relatively large and/or complex bony walls. Based on these requirements, novel uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets could be used as innovative, bioactive, and osteoconductive/bioresorbable implant materials for orbital reconstruction. In addition, intraoperative navigation is a powerful tool. Navigation- and computer-assisted surgeries have improved execution and predictability, allowing for greater precision, accuracy, and minimal invasiveness during orbital trauma reconstructive surgery of relatively complex and large orbital wall defects with ophthalmological malfunctions and deformities. This review presents an overview of navigation-assisted orbital trauma reconstruction using a bioactive, osteoconductive/bioresorbable u-HA/PLLA system.

Keywords: Navigation; Orbital reconstruction; Orbital trauma; u-HA/PLLA.

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Conflict of interest statement

Conflict of interestThe authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
a Components of an intraoperative surgical navigation system. Navigation system is comparable to a Global Positioning System (GPS) commonly used in automobiles and is composed of three primary components. b Two main types of navigation system currently available: optical (left) and electromagnetic (right)
Fig. 2
Fig. 2
a Maxillofacial osteosynthesis systems using third-generation bioactive/bioresorbable materials, the SuperFIXORB-MX® (OSTEOTRANS-MX®) system; TEIJIN Medical Technologies Co., Ltd, Osaka, Japan. b The currently available two main types of intraoperative navigation systems for our routine complex orbital trauma reconstructive surgery: optical surgical navigation system (left:; Brainlab, Feldkirchen, Germany) and electromagnetic surgical navigation systems (right: the StealthStation, Medtronic, Inc., Louisville, Colorado, USA)
Fig. 3
Fig. 3
A 17-year-old male patient with left maxilla and nasoorbital–ethmoid fracture with a large combined orbital floor and medial walls defect fracture of type IV defect [10]. a Preoperative CT scans. b The original preoperative 3D-model image was evaluated overlapping the mirrored 3D-model image for 3D morphological individual customization of u-HA/PLLA sheets using the stereolithographic model and testing paper. c An intraoperative photograph showing the single-folded u-HA/PLLA sheet reconstruction with tack fixation under surgical navigation assistance. d 12 months postoperative CT scans
Fig. 4
Fig. 4
A 68-year-old male patient with right maxilla and nasoorbital–ethmoid fracture with a large combined orbital floor and medial walls defect fracture of type IV defect. a Preoperative CT scans. b The original preoperative CT images were evaluated overlapping the mirrored CT images from the uninjured side for up-to-date 3D morphological precise individual customization of u-HA/PLLA sheets using the actual orbital simulation stereolithographic model (Yasojima Proceed Co., Ltd, Osaka, Japan). c An intraoperative photograph showing the u-HA/PLLA sheet reconstruction with tack fixation under surgical navigation assistance. d Postoperative CT scans

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