Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 11;11(12):3361.
doi: 10.3390/jcm11123361.

Primary Orbital Reconstruction with Selective Laser Melting (SLM) of Patient-Specific Implants (PSIs): An Overview of 96 Surgically Treated Patients

Majeed Rana  1 , Henriette L Moellmann  1 , Lara Schorn  1 , Julian Lommen  1 , Madiha Rana  2 , Max Wilkat  1 , Karsten Hufendiek  3
Affiliations

Primary Orbital Reconstruction with Selective Laser Melting (SLM) of Patient-Specific Implants (PSIs): An Overview of 96 Surgically Treated Patients

Majeed Rana et al. J Clin Med. .

Abstract

Contemporary advances in technology have allowed the transfer of knowledge from industrial laser melting systems to surgery; such an approach could increase the degree of accuracy in orbital restoration. The aim of this study was to examine the accuracy of selective laser melted PSIs (patient-specific implants) and navigation in primary orbital reconstruction. Ninety-six patients with orbital fractures were included in this study. Planned vs. achieved orbital volumes (a) and angles (b) were compared to the unaffected side (n = 96). The analysis included the overlay of post-treatment on planned images (iPlan 3.0.5, Brainlab®, Feldkirchen, Germany). The mean difference in orbital volume between the digitally planned orbit and the postoperative orbit was 29.16 cm3 (SD 3.54, presurgical) to 28.33 cm3 (SD 3.64, postsurgical, t = 5.00, df = 95.00; p < 0.001), resulting in a mean volume difference (planned vs. postop) of less than 1 cm3. A 3D analysis of the color mapping showed minor deviations compared to the mirrored unaffected side. The results suggested that primary reconstruction in complex orbital wall fractures can be routinely achieved with a high degree of accuracy by using selective laser melted orbital PSIs.

Keywords: 3D mesh; customized implant; intraoperative navigation; orbital reconstruction; orbital wall fracture; selective laser melting.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A selective laser melted patient-specific implant designed for the left orbit, two wall reconstruction. A horizontal drainage system is incorporated throughout. Navigational landmarks and guides are provided to facilitate implant placement with intraoperative navigation. Screw holes are placed anteriorly for fixation to the inferior orbital rim.
Figure 2
Figure 2
Intraoperative navigation used to confirm correct implant position. (Upper left): pointer resting on a navigational landmark of the PSI. (Upper right, Lower right and left): screenshots showing position of pointer in axial, sagittal and coronal views (tip of pointer is represented by the centre of the green crosshairs).
Figure 3
Figure 3
(Upper left): screenshot showing pointer has reached the navigation landmark. (Upper right, Lower right and left): screenshots showing position of pointer in axial, sagittal and coronal views (tip of pointer is represented by the centre of the green crosshairs).
Figure 4
Figure 4
Bar graph showing the postoperative angular deviation from the unaffected orbit (planned reconstruction).
See this image and copyright information in PMC

References

    1. Manolidis S., Weeks B.H., Kirby M., Scarlett M., Hollier L. Classification and surgical management of orbital fractures: Experience with 111 orbital reconstructions. J. Craniofac. Surg. 2002;13:726–737; discussion 738. doi: 10.1097/00001665-200211000-00002. - DOI - PubMed
    1. Jank S., Schuchter B., Emshoff R., Strobl H., Koehler J., Nicasi A., Norer B., Baldissera I. Clinical signs of orbital wall fractures as a function of anatomic location. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol. 2003;96:149–153. doi: 10.1016/S1079-2104(03)00317-2. - DOI - PubMed
    1. Tong L., Bauer R.J., Buchman S.R. A current 10-year retrospective survey of 199 surgically treated orbital floor fractures in a nonurban tertiary care center. Plast. Reconstr. Surg. 2001;108:612–621. doi: 10.1097/00006534-200109010-00003. - DOI - PubMed
    1. Shere J.L., Boole J.R., Holtel M.R., Amoroso P.J. An analysis of 3599 midfacial and 1141 orbital blowout fractures among 4426 United States Army Soldiers, 1980–2000. Otolaryngol.—Head Neck Surg. Off. J. Am. Acad. Otolaryngol.-Head Neck Surg. 2004;130:164–170. doi: 10.1016/j.otohns.2003.09.018. - DOI - PubMed
    1. Chi M.J., Ku M., Shin K.H., Baek S. An analysis of 733 surgically treated blowout fractures. Ophthalmologica. 2010;224:167–175. doi: 10.1159/000238932. - DOI - PubMed

LinkOut - more resources