Virtual Planning and 3D Printing in the Management of Acute Orbital Fractures and Post-Traumatic Deformities

Abstract

Virtual surgical planning (VSP) and three-dimensional (3D) printing have advanced surgical reconstruction of orbital defects. Individualized 3D models of patients' orbital bony and soft tissues provide the surgeon with corrected orbital volume based on normalized anatomy, precise location of critical structures, and when needed a better visualization of the defect or altered anatomy that are paramount in preoperative planning. The use of 3D models preoperatively allows surgeons to improve the accuracy and safety of reconstruction, reduces intraoperative time, and most importantly lowers the rate of common postoperative complications, including over- or undercontouring of plates, orbital implant malposition, enophthalmos, and hypoglobus. As 3D printers and materials become more accessible and cheaper, the utility of printing patient-specific implants becomes more feasible. This article summarizes the traditional surgical management of orbital fractures and reviews advances in VSP and 3D printing in this field. It also discusses the use of in-house (point-of-care) VSP and 3D printing to further advance care of acute orbital trauma and posttraumatic deformities.

Keywords: orbital fracture; orbital reconstruction; point-of-care; three-dimensional printing; virtual surgical planning.

Fig. 1

Transcaruncular approach to the medial orbit may be necessary to access the medial wall and can be combined with a transconjunctival lower eyelid incision to access the floor when necessary.

Fig. 2

Virtual measurement of intraorbital volumes prior to surgical management of enophthalmos, globe malposition, and diplopia. The calculated left orbital volume was 31.4 mL, and the right orbital volume was 30.8 mL, both significantly larger than the average male orbital volume (see text).

Fig. 3

( A ) Maxillofacial CT with 3D reconstruction demonstrating the comminuted nature and contour deformity of the left inferior orbital rim and anterior maxilla. ( B ) and ( C ) demonstrate the contour deformity of the left rim and anterior maxilla prior to and after open reduction and internal fixation of fractures using VSP and 3D printing.

Fig. 4

( A ) Printed 3D model of the traumatized facial skeleton showing left orbital floor blowout fracture with inferior rim comminution. ( B ) Printed 3D model at the point-of-care after VSP with left orbito-maxillary anatomy created by mirroring the normal right side onto the left side. ( C ) 3D printed model used intraoperatively to contour the orbital floor implant.

Fig. 5

An illustration of VSP using a precontoured plate based on perfected anatomy. ( A ) Plate fixated medially and laterally on unaffected bone prior to reduction of rim fractures. The plate was used as a guide to reestablish accurate symmetry and contour with the right side. ( B ) After reduction and fixation of the inferior rim fractures.

Fig. 6

Three-dimensional (3D) printed models enhance resident education. The surgical anatomy is reviewed and when necessary, plates are bent preoperatively or mock surgery can be performed ahead of surgery in complex cases.