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. 2020 Jan-Jun;10(1):3-9.
doi: 10.4103/ams.ams_183_19. Epub 2020 Jun 8.

Three-Dimensional Diagnosis in Orbital Reconstructive Surgery

Chingiz R Rahimov  1 , Sirajaddin G Ahmadov  1 , Masuma Ch Rahimli  2 , Ismayil M Farzaliyev  1
Affiliations

Three-Dimensional Diagnosis in Orbital Reconstructive Surgery

Chingiz R Rahimov et al. Ann Maxillofac Surg. 2020 Jan-Jun.

Abstract

Introduction: Orbital floor fractures are common among mid-face fractures. The general aim of treatment is to restore orbital volume and anatomy with grafts or reconstructive materials. Malpositioning of the implants and inadequate volume restorations are common complications of these procedures. The aim of our study is to present the surgical outcomes of orbital reconstruction aided by our algorithm of patient-specific virtual planning.

Materials and methods: The current study was performed on 77 patients with orbital wall fractures who were categorized into two groups: Group A - 42 patients (virtual planning) and Group B - 35 patients (traditional approach). Criteria of analysis included the presence of diplopia postoperatively and duration of surgical procedures.

Results: Diplopia was recorded right after surgery in 16 cases (38.1%) of Group A and in 12 cases (34.3%) of Group B. However, 6 months postreconstruction, residual diplopia was recorded in 4 cases (9.5%) of Group A and in 12 cases (34.3%) of Group B. Mean operation time in Group A for the patients with isolated zygoma fracture was 2.23 h; for isolated orbital wall fracture was 1.98 h; and for combined zygoma, orbital wall, and facial bone fracture was 3.07 h. In Group B, these indexes were 3.47, 2.05, and 3.31 h, respectively.

Conclusions: Application of virtual planning could significantly improve postoperative outcomes in orbital reconstruction. However, application of this technology could be limited by complicated defects of the orbital walls, which would require complex shape of the implant that might be difficult to be prevent virtually.

Keywords: Orbital floor fractures; orbital reconstruction; virtual planning.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of the cause of injury
Figure 2
Figure 2
Distribution of the site of injury
Figure 3
Figure 3
Layout 1 – Algorithm of preoperative virtual planning
Figure 4
Figure 4
Comparison of diplopia indexes within groups directly and 6 months after surgical reconstruction
Figure 5
Figure 5
The indexes of surgical procedure duration within groups according to diagnosis
Figure 6
Figure 6
Clinical evaluation of the patient revealed limitation of the movements of the right eyeball in the upper quadrant
Figure 7
Figure 7
Computed tomography scan of the patient: Inferior orbital wall fracture and protrusion of orbital components toward defect
Figure 8
Figure 8
The algorithm of virtual planning: (a) Importing of computed tomography scan data to Materialise Mimics 17.0 software and cropping of the region of interest; (b) acquiring of perimeter and reference lines; (c) fabrication of virtual template based on this lines; (d) assessment of positioning of virtual template related to facial skeleton in three-dimensional; (e) assessment of positioning of virtual template related to facial skeleton in two-dimensional; (f) measurement of longitudinal and transversal dimensions of template with taking into account its curvature
Figure 9
Figure 9
Eyeball movements a month after surgery
Figure 10
Figure 10
Position of orbital implant in two- and three-dimensional views
Figure 11
Figure 11
Clinical evaluation of the patient: Limitation of the movements of the right eyeball in upper and lateral quadrant
Figure 12
Figure 12
Clinical evaluation of the patient: Significant deformity of right zygoma-orbital complex and significant R-side enophthalmos
Figure 13
Figure 13
Computed tomography scan of the patient: Inferior orbital wall fracture and protrusion of orbital components toward defect; dislocation of the right malar bone
Figure 14
Figure 14
The algorithm of virtual planning: (a) virtual osteotomy of right malar bone; (b) mirroring of opposite site; (c) virtual fabrication of orbital implant; (d) positioning of virtual implant; (e) measurement of longitudinal and transversal dimensions of template with taking into account its curvature; (f) virtual repositioning of osteotomized malar bone and registration of anatomical landmarks
Figure 15
Figure 15
Surgical reconstruction: (a) detection and removal of old hardware; (b) installation of orbital implant
Figure 16
Figure 16
Eyeball movements after surgical reconstruction
Figure 17
Figure 17
Facial appearance after surgical reconstruction
Figure 18
Figure 18
Postoperative computed tomography scan: Adequate position of malar bone and orbital implant
See this image and copyright information in PMC

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