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Volume 15
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10.3390/jcm15030937
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation

by
Gonzalo Ruiz-de-Leon
1,†,
Manuel Tousidonis
1,2,3,*,†,
Jose-Ignacio Salmeron
1,2,
Ruben Perez-Mañanes
2,3,
Sara Alvarez-Mokthari
1,
Marta Benito-Anguita
1,
Borja Gonzalez-Moure
1,
Diego Fernandez-Acosta
1,
Susana Gomez de los Infantes-Peña
2,3,
Myriam Rodriguez-Rodriguez
2,3,
Carlota Ortiz-Garcia
2,3,
Ismael Nieva-Pascual
2,4,
Pilar Cifuentes-Canorea
2,4,
Jose-Luis Urcelay
2,4 and
Santiago Ochandiano
1,2,†
1
Department of Oral and Maxillofacial Surgery, Gregorio Marañon University Hospital, 28007 Madrid, Spain
2
Gregorio Marañón Research Institute, 28007 Madrid, Spain
3
Advanced Planning and 3D Manufacturing Unit (UPAM3D), Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007 Madrid, Spain
4
Department of Ophthalmology, Gregorio Marañon University Hospital, 28007 Madrid, Spain
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2026, 15(3), 937; https://doi.org/10.3390/jcm15030937 (registering DOI)
Submission received: 23 December 2025 / Revised: 7 January 2026 / Accepted: 13 January 2026 / Published: 23 January 2026
(This article belongs to the Special Issue Surgical Management of Maxillofacial Fractures and Reconstruction of Facial Deformities)
Versions Notes

Abstract

Background: Orbital dermoid cysts are common benign lesions; however, deep-seated or recurrent lesions near the orbital apex pose major surgical challenges due to their proximity to critical neurovascular structures. Lateral orbitotomy remains the reference approach, but accurate osteotomies and stable reconstruction can be difficult to achieve using conventional techniques. This study reports our initial experience using a fully digital, hospital-based point-of-care (POC) workflow to enhance precision and safety in complex orbital dermoid cyst surgery. Methods: We present a case series of three patients with orbital dermoid cysts treated at a tertiary center (2024–2025) using a comprehensive digital workflow. Preoperative assessment included CT and/or MRI followed by virtual surgical planning (VSP) with orbit–tumor segmentation and 3D modeling. Cutting guides and patient-specific implants (PSIs) were manufactured in-house under a certified hospital-based POC protocol. Surgical strategies were tailored to each lesion and included piezoelectric osteotomy, intraoperative navigation, intraoperative CT, and structured-light scanning when indicated. Results: Complete en bloc resection was achieved in all cases without capsular rupture or optic nerve injury. Intraoperative CT confirmed complete lesion removal and accurate PSI positioning and fitting. Structured-light scanning enabled radiation-free postoperative monitoring when used. All patients preserved full ocular motility, visual acuity, and facial symmetry, with no complications or recurrences during follow-up. Conclusions: The integration of VSP, in-house POC manufacturing, and image-guided surgery within a lateral orbitotomy approach provides a reproducible and fully integrated workflow. This strategy appears to improve surgical precision and safety while supporting optimal long-term functional and aesthetic outcomes in challenging orbital dermoid cyst cases.
Keywords: orbitotomy; orbital neoplasms; virtual surgical planning; intraoperative navigation; patient-specific implants; piezoelectric surgery; structured light scanning; three-dimensional printing orbitotomy; orbital neoplasms; virtual surgical planning; intraoperative navigation; patient-specific implants; piezoelectric surgery; structured light scanning; three-dimensional printing

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MDPI and ACS Style

Ruiz-de-Leon, G.; Tousidonis, M.; Salmeron, J.-I.; Perez-Mañanes, R.; Alvarez-Mokthari, S.; Benito-Anguita, M.; Gonzalez-Moure, B.; Fernandez-Acosta, D.; Gomez de los Infantes-Peña, S.; Rodriguez-Rodriguez, M.; et al. Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation. J. Clin. Med. 2026, 15, 937. https://doi.org/10.3390/jcm15030937

AMA Style

Ruiz-de-Leon G, Tousidonis M, Salmeron J-I, Perez-Mañanes R, Alvarez-Mokthari S, Benito-Anguita M, Gonzalez-Moure B, Fernandez-Acosta D, Gomez de los Infantes-Peña S, Rodriguez-Rodriguez M, et al. Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation. Journal of Clinical Medicine. 2026; 15(3):937. https://doi.org/10.3390/jcm15030937

Chicago/Turabian Style

Ruiz-de-Leon, Gonzalo, Manuel Tousidonis, Jose-Ignacio Salmeron, Ruben Perez-Mañanes, Sara Alvarez-Mokthari, Marta Benito-Anguita, Borja Gonzalez-Moure, Diego Fernandez-Acosta, Susana Gomez de los Infantes-Peña, Myriam Rodriguez-Rodriguez, and et al. 2026. "Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation" Journal of Clinical Medicine 15, no. 3: 937. https://doi.org/10.3390/jcm15030937

APA Style

Ruiz-de-Leon, G., Tousidonis, M., Salmeron, J.-I., Perez-Mañanes, R., Alvarez-Mokthari, S., Benito-Anguita, M., Gonzalez-Moure, B., Fernandez-Acosta, D., Gomez de los Infantes-Peña, S., Rodriguez-Rodriguez, M., Ortiz-Garcia, C., Nieva-Pascual, I., Cifuentes-Canorea, P., Urcelay, J.-L., & Ochandiano, S. (2026). Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation. Journal of Clinical Medicine, 15(3), 937. https://doi.org/10.3390/jcm15030937

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