Prebending of Prefabricated Orbital Implants: Towards Improved Orbital Angle Symmetry Post Craniofacial Trauma Surgery

Purpose: Reconstructive surgery after craniofacial trauma aim to restore orbital anatomy for function and aesthetic reasons. The purpose of this study is to improve postoperative orbital symmetry with the use of prebent prefabricated titanium implants. Methods: In this retrospective study, patients with combined unilateral medial wall and floor fractures who underwent orbital reconstruction surgery were selected. The angle of inferomedial orbital strut (AIOS) was measured at 3 standard locations on preoperative facial computed tomography guided scans of the nonfractured orbit in the coronal view and used as a guide to bend the prefabricated titanium implants intraoperatively. The corresponding values were measured on the postoperative computed tomography and compared for symmetry. Results: Out of 83 patients recruited for the study, 54 were in the prebent group while 29 were in the control group. All other demographics were similar among the 2 groups. Anterior AIOS has a difference of 4.9° between 2 orbits in the prebent group whereas a difference of 15.5° was noted in the nonprebent group. For middle AIOS, a difference of 4.7° was noted in the prebent group whereas nonprebent group had a difference of 14.1°. For posterior AIOS, the prebent group had a difference of 3.8° versus 14.1° in the nonprebent group. The difference in AIOS at all 3 points between the prebent and nonprebent group were significant. Conclusions: Anatomical prefabricated titanium plates are versatile implants that facilitate orbital reconstruction. Prebending of these implants according to the fellow orbit can achieve better surgical outcomes in a cost-effective manner.

[1]  M. Wagner,et al.  Concept of patient-specific shape memory implants for the treatment of orbital floor fractures , 2017, Oral and Maxillofacial Surgery.

[2]  P. Tsay,et al.  Evolving concepts in the management of orbital fractures with enophthalmos: A retrospective comparative analysis , 2016 .

[3]  Juliana Bonilla-Velez,et al.  Management of orbital fractures: challenges and solutions , 2015, Clinical ophthalmology.

[4]  Tae Gon Kim,et al.  Combined Orbital Fractures: Surgical Strategy of Sequential Repair , 2015, Archives of plastic surgery.

[5]  Harald Essig,et al.  Patient specific implants (PSI) in reconstruction of orbital floor and wall fractures. , 2015, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[6]  G. Sundar,et al.  Survey of Common Practices among Oculofacial Surgeons in the Asia-Pacific Region: Management of Orbital Floor Blowout Fractures , 2014, Craniomaxillofacial trauma & reconstruction.

[7]  Sukwha Kim,et al.  Three-Dimensional Pre-Bent Titanium Implant for Concomitant Orbital Floor and Medial Wall Fractures in an East Asian Population , 2014, Archives of plastic surgery.

[8]  Jayanthi Parthasarathy,et al.  3D modeling, custom implants and its future perspectives in craniofacial surgery , 2014, Annals of maxillofacial surgery.

[9]  B. Davies,et al.  Combined Orbital Floor and Medial Wall Fractures Involving the Inferomedial Strut: Repair Technique and Case Series Using Preshaped Porous Polyethylene/Titanium Implants , 2013, Craniomaxillofacial trauma & reconstruction.

[10]  P L Evans,et al.  Customized titanium reconstruction of post-traumatic orbital wall defects: a review of 22 cases. , 2011, International journal of oral and maxillofacial surgery.

[11]  M. Stamminger,et al.  Secondary reconstruction of posttraumatic enophthalmos: prefabricated implants vs titanium mesh. , 2011, Archives of facial plastic surgery.

[12]  Marcin Elgalal,et al.  Treatment with individual orbital wall implants in humans - 1-Year ophthalmologic evaluation. , 2011, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[13]  Forrest S. Roth,et al.  Pearls of Orbital Trauma Management , 2010, Seminars in plastic surgery.

[14]  P. Andrades,et al.  Degrees of tolerance in post-traumatic orbital volume correction: the role of prefabricated mesh. , 2009, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[15]  P. Scolozzi,et al.  Accuracy and Predictability in Use of AO Three-Dimensionally Preformed Titanium Mesh Plates for Posttraumatic Orbital Reconstruction: A Pilot Study , 2009, The Journal of craniofacial surgery.

[16]  W. Nunery,et al.  Orbital Adherence Syndrome Secondary to Titanium Implant Material , 2009, Ophthalmic plastic and reconstructive surgery.

[17]  M. Metzger,et al.  Semiautomatic Procedure for Individual Preforming of Titanium Meshes for Orbital Fractures , 2007, Plastic and reconstructive surgery.

[18]  L. Hollier,et al.  Classification and Surgical Management of Orbital Fractures: Experience With 111 Orbital Reconstructions , 2002, The Journal of craniofacial surgery.

[19]  R. Goldberg,et al.  The Inferomedial Orbital Strut: An Anatomic and Radiographic Study , 2002, Ophthalmic plastic and reconstructive surgery.

[20]  S. Oh,et al.  Pure orbital blowout fracture: new concepts and importance of medial orbital blowout fracture. , 1999, Plastic and reconstructive surgery.

[21]  Martin Groten,et al.  Orbital Reconstruction with Individually Copy‐Milled Ceramic Implants , 1997, Plastic and reconstructive surgery.

[22]  R. Mathog,et al.  Medial orbital wall fractures: classification and clinical profile. , 1995, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.