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Case Reports
. 2023 May-Aug;14(2):326-329.
doi: 10.4103/njms.njms_85_22. Epub 2023 Jul 13.

Late patient-fitted total orbital reconstruction for facial gunshot wound sequelae

Leonardo A P F Pinto  1   2 , Bernardo C Lima  3 , Giulianna L Pinheiro  4 , Gustavo G N Rodrigues  2
Affiliations
Case Reports

Late patient-fitted total orbital reconstruction for facial gunshot wound sequelae

Leonardo A P F Pinto et al. Natl J Maxillofac Surg. 2023 May-Aug.

Abstract

Late reconstructions of gunshot wounds (GSWs) in the orbital area are a true challenge to the oral and maxillofacial surgeon. Usually, the wall defects are large in size and commonly present loss of orbital volume, which can cause ocular dystopia. The only exceptions are when there is an explosion of the orbital walls-that is, blow-out fractures. We encountered a patient with a two-year sequelae after GSW in the face that caused the destructed orbit to have a 2.5 bigger size than the contralateral orbit, requiring meticulous planning of a patient-specific implant (PSI) to correctly reconstruct the orbit volume and bone projection. The PSI was developed using titanium and it had three pieces that could reconstruct all four walls of the orbit. After surgery, the patient regained orbital volume and malar projection, allowing him to benefit from facial symmetry. The PSI can be used to reconstruct all the orbital walls in cases of complex bone defects.

Keywords: Customized reconstruction; gunshot wound; orbital reconstruction; orbital trauma; patient fitted implant.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Frontal and oblique view of the patient face showing disfiguration and scar formation from the GSW in the left orbit region
Figure 2
Figure 2
CT scan 3D reconstruction and stereolithographic 3D model from the patient with the difference from the right to the left orbit. Left orbit was 2.5 × greater than the right one
Figure 3
Figure 3
Virtual design of the total orbit PSI using mirroring technique. Right and left orbit have the same volume and size. Note that it is divided into three pieces that together reconstruct all four orbital walls. It is possible to see the 23 roles for fixation screws and their position to hold the PSI in the bone. Von Mises finite element analysis of the PSI was done.
Figure 4
Figure 4
Marking of the bicoronal and infraorbital surgical approaches
Figure 5
Figure 5
PSI components placed reconstructing the four walls of the orbit
Figure 6
Figure 6
Immediate postoperative CT. Note the correct volume, size and height of the reconstructed orbit compared to the contralateral orbit
Figure 7
Figure 7
Frontal and oblique postoperative view of the patient
See this image and copyright information in PMC

References

    1. Deveci M, Sengenzer M, Selmanpakoglu M. Reconstruction of gunshot wounds of the face. Gazi Med J. 1998;9:47–56.
    1. Siberchicot F, Pinsolle J, Majoufre C, Ballanger A, Gomez D, Caix P. Traumatismes faciaux par arme de chasse àcanon lisse. Analyse d'une série de 165 cas et réévaluation du traitement primaire [Gunshot injuries of the face. Analysis of 165 cases and reevaluation of the primary treatment] Ann Chir Plast Esthet. 1998;43:132–40. French. Erratum in:Ann Chir Plast Esthet 1998;43:286. - PubMed
    1. Converse JM, Cole G, Smith B. Late treatment of blowout fracture of the floor of the orbit. A case report. Probl Sovrem Neirokhirurgii. 1961;28:183–91. - PubMed
    1. Manson PN, Clifford CM, Su CT, Iliff NT, Morgan R. Mechanisms of global support and posttraumatic enophthalmos:I. The anatomy of the ligament sling and its relation to intramuscular cone orbital fat. Plast Reconstr Surg. 1986;77:193–202. - PubMed
    1. Schramm A, Suarez-Cunqueiro MM, Rücker M, Kokemueller H, Bormann KH, Metzger MC, Gellrich NC. Computer-assisted therapy in orbital and mid-facial reconstructions. Int J Med Robot. 2009;5:111–24. - PubMed

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