Search Results (64)

Three-dimensional (3D) printing enables accurate implant pre-shaping in orbital reconstruction but is costly and time-consuming. Naked-eye stereoscopic displays (NEDs) enable virtual implant modeling without fabrication. This study aimed to compare the reproducibility and accuracy of NED-based virtual reality (VR) pre-shaping with conventional 3D-printed models. Two surgeons pre-shaped implants for 11 unilateral orbital floor fractures using both 3D-printed and NED-based VR models with identical computed tomography data. The depth, area, and axis dimensions were measured, and reproducibility and agreement were assessed using intraclass correlation coefficients (ICCs), Bland–Altman analysis, and shape similarity metrics—Hausdorff distance (HD) and root mean square error (RMSE). Intra-rater ICCs were ≥0.80 for all parameters except depth in the VR model. The HD and RMSE reveal no significant differences between 3D (2.64 ± 0.85 mm; 1.02 ± 0.42 mm) and VR (3.14 ± 1.18 mm; 1.24 ± 0.53 mm). Inter-rater ICCs were ≥0.80 for the area and axes in both modalities, while depth remained low. Between modalities, no significant differences were found; HD and RMSE were 2.95 ± 0.94 mm and 1.28 ± 0.49 mm. The NED-based VR pre-shaping achieved reproducibility and dimensional agreement comparable to 3D printing, suggesting a feasible cost- and time-efficient alternative for orbital reconstruction. These preliminary findings suggest that NED-based preshaping may be feasible; however, larger studies are required to confirm whether VR can achieve performance comparable to 3D-printed models. Full article

Background/Objectives: Isolated orbital floor fractures are a common consequence of midfacial trauma and are frequently associated with functional and aesthetic complications such as diplopia, enophthalmos, infraorbital hypoesthesia, restricted ocular motility, and, in rare cases, blindness. Current therapeutic approaches vary significantly between different surgeons. This systematic review aimed to evaluate different treatment strategies for isolated orbital floor fractures to determine the most effective approaches. Methods: Electronic systematic searches were conducted using keywords to identify studies reporting isolated orbital floor fractures. Publications were screened for eligibility, and relevant data were extracted and evaluated. Results: This systematic review included 444 patients from 27 selected studies. 42 patients were treated conservatively, while 381 underwent various surgical interventions. Overall, the mentioned treatment modalities were successful in correcting enophthalmos (85.2%), diplopia (74.8%), ocular motility restriction (61.6%), and sensory disturbances (61.1%) in their respective patient cohorts. The complication and reoperation rates for the surgical interventions were low during the follow-up periods ranging from 6 weeks to 10 years. The timing, surgical approach, and reconstructive technique varied widely across the studies. Conclusions: Both conservative and surgical management of isolated orbital floor fractures can achieve satisfactory clinical outcomes. Clinical symptoms, defect size, and the surgeon’s preference define the ideal treatment modality. Full article

Orbital floor fractures are primarily caused by blunt trauma to the area around the eyes. These injuries most commonly affect the orbital floor and medial wall due to the fragility of these structures. The mechanism typically involves transmission of force through the orbital rim or an acute increase in intraorbital pressure caused by globe displacement. Blowout fractures often occur alongside additional maxillofacial fractures and periorbital soft tissue injuries. The reported causes mirror those of general maxillofacial trauma and include motor vehicle collisions, interpersonal violence, falls, sports-related injuries, incidents involving firearms, and occupational accidents. Here, we present the case of a 56-year-old male patient who sustained an exceptionally rare injury pattern characterized by a complete orbital floor fracture with globe dislocation into the maxillary sinus. Such extensive fractures are associated with significant functional impairments, including diplopia, enophthalmos, and restricted extraocular muscle movement, as well as marked aesthetic deformity. Comprehensive diagnostic imaging, comprising coronal, sagittal, and three-dimensional CT reconstructions, was crucial for accurately assessing the extent of bony disruption and soft tissue involvement. Particular emphasis should be placed on imaging that clearly delineates the extraocular muscles and the optic nerve, as precise evaluation of these structures is essential for surgical planning and prognosis. Surgical management involved repositioning of the globe and the orbital contents, followed by reconstruction of the orbital floor using a titanium mesh anchored to the infraorbital rim. This case highlights the technical challenges of total orbital floor reconstruction, emphasizing the importance of meticulous anatomical restoration for achieving optimal functional and aesthetic outcomes. Full article

Background and Objectives: Orbital floor fractures are challenging to treat, due to the complex orbital anatomy and limited surgical access. Emerging technologies—such as virtual surgical planning (VSP), 3D printing, patient-specific implants (PSIs), and intraoperative navigation—offer promising advancements to improve the surgical precision and clinical outcomes. This review systematically evaluates and synthesizes current technological modalities with respect to their accuracy, operative duration, cost-effectiveness, and postoperative functional outcomes. Materials and Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. The PubMed, Scopus, and PRIMO databases were searched for clinical studies published between 2019 and September 2024. Out of 229 articles identified, 9 met the inclusion criteria and were analyzed using the PICO framework. Results: VSP and 3D printing enhanced diagnostics and presurgical planning, offering improved accuracy and reduced planning time. Pre-bent PSIs shaped on 3D models showed superior accuracy, lower operative times, and better cost efficiency compared to intraoperative mesh shaping. Custom-designed PSIs offered high precision and clinical benefit but required a longer production time. Intraoperative navigation improved implant positioning and reduced the complication rates, though a detailed cost analysis remains limited. Conclusions: VSP, 3D printing, and intraoperative navigation significantly improve surgical planning and outcomes in orbital floor reconstruction. Pre-bent PSIs provide a time- and cost-effective solution with strong clinical performance. While customized PSIs offer accuracy, they are less practical in time-sensitive settings. Navigation systems are promising tools that enhance outcomes and may serve as an alternative to custom implants when time or resources are limited. Full article

Background/Objectives: Orbital fractures are common facial injuries that require precise reconstruction to restore both function and esthetics. Heterologous cortical lamina and titanium preformed meshes are widely used for orbital wall reconstruction; however, comparative data on their outcomes remain limited. Methods: This retrospective observational study analyzed 67 patients treated for orbital fractures at Santa Maria Hospital, Terni, between January 2021 and November 2024. Patients underwent orbital reconstruction using either a heterologous cortical lamina or titanium mesh. Clinical data, including demographics, trauma etiology, fracture characteristics, surgical approach, and postoperative complications were collected. Outcomes such as diplopia, enophthalmos, ocular motility, and sensory impairment were assessed preoperatively and postoperatively and compared between groups. Statistical analyses included Chi-square and Mann–Whitney U tests, with logistic regression to identify risk factors for complications. Results: Accidental falls were the leading cause of injury (46.3%), with the orbital floor being the most commonly affected site (83.6%). Postoperative complications occurred in 15% of patients, with diplopia significantly reduced from 47.8% preoperatively to 10.4% postoperatively (p < 0.05). Sensory impairment and motility restrictions also improved significantly. Patients reconstructed using heterologous cortical lamina experienced significantly fewer postoperative complications compared to those treated with titanium mesh (OR = 0.171, 95% CI: 0.023–0.799, p = 0.040). Conclusions: Both heterologous cortical lamina and titanium mesh provide effective orbital reconstruction; however, the heterologous cortical lamina was associated with fewer postoperative complications, particularly diplopia and sensory impairment. Material selection should consider the fracture complexity, patient characteristics, and potential long-term outcomes. Full article

Background/Objectives: Orbital fractures are a very serious problem due to the close location of the eyeball and a direct path to brain injuries, which is associated with serious consequences. This study aims to assess the usefulness of the Orbital Destruction Intensity (ODI) scale. Additionally, this article includes elements of an epidemiological study. Methods: A retrospective study of 160 patients admitted to the Department of Maxillofacial Surgery in Łódź (Poland) between January 2021 and June 2024 was conducted. In this study, general patient information (gender, age), details about the injuries (cause, affected orbit, accompanying symptoms), diagnosis (ODI scale, pathological classification), and treatment were assessed. Analysis of the distribution of features and regression analysis was performed in the case of quantitative data. To compare the assessment of the impact of a categorical variable on a quantitative variable, the Kruskal–Wallis test was used. A p-value of less than 0.05 was considered statistically significant. Results: The main cause of the accident was assault, which accounted for 39% of cases. An X-ray examination showed that patients had an average ODI score of 2.92 ± 1.69. Patients with low ODI scores mostly had isolated fractures of the orbital floor. As ODI scores increased, zygomaticomaxillary complex (ZMCO) fractures became more common as an additional fracture (p < 0.05). For patients with low ODI scores, treatment generally involves reconstructing the orbital wall with titanium mesh. For those with higher ODI scores, treatment may include microplate osteosynthesis or a combination of both methods (p < 0.05). Conclusions: A correlation was observed between the diagnosis based on ODI, anatomical classification, and the treatment provided. This relationship is related to the nature of the ODI scale, as, when the severity of the injury increases, additional anatomical structures (walls or rims of the orbit) are included. Full article

The zygomatic bone area experiences frequent mechanical damage in the middle craniofacial region, including the orbital floor. The orbital floor bone is very thin, ranging from 0.74 mm to 1.5 mm. Enhancing digitization, reconstruction, and CAD modeling procedures is essential to improving the visualization of this structure. Achieving a homogeneous surface with high manufacturing accuracy is crucial for developing precise surgical models and tools for creating titanium mesh implants to reconstruct the orbital floor geometry. This article improved the accuracy of reconstruction and CAD modeling using the example of the development of a prototype implant to replace the zygomatic bone and a tool to form the geometry of the titanium mesh within the geometry of the orbital floor. The masked stereolithography (mSLA) method was used in the model manufacturing process because it is low-cost and highly accurate. Two manufacturing modes (standard and ultra-light) were tested on an Anycubic Photon M3 Premium 3D printer to determine which mode produced a more accurate representation of the geometry. To verify the geometric accuracy of the manufactured models, a GOM Scan1 structured light scanner was used. In the process of evaluating the accuracy of the model preparation, the maximum deviation, mean deviation, range and standard deviation were determined. The maximum deviations for anatomical structures created using the normal mode ranged from ±0.6 mm to ±0.7 mm. In contrast, models produced with the ultra-light mode showed deviations of ±0.5 mm to ±0.6 mm. Furthermore, the results indicate that the ultra-light mode offers better surface accuracy for die and stamp models. More than 70% of the surface of the models is within the deviation range of ±0.3 mm, which is sufficient for planning surgical procedures. However, the guidelines developed in the presented publication need to optimize the CAD process and select 3D-printing parameters to minimize deviations, especially at the edges of manufactured models. Full article

Background: The malar bone provides an anchorage point for zygomatic implants, avoiding invasive reconstructive surgeries in the fixed rehabilitation of fully edentulous and severely atrophic maxillae. The limited bone volume, however, requires precise implant placement to prevent complications related to nearby anatomical structures. This observational cross-sectional study aims to measure the malar and zygomatic arch bones and their distances from critical anatomical landmarks to guide surgeons in safe zygomatic implant placement. Methods: Dissections were performed bilaterally on 29 heads from human donated bodies in a cross-sectional observational study. Key landmarks evaluated include the infraorbital foramen (IF), pyriform nasal aperture (PNA), infraorbital margin (IM), zygomaticofacial foramen (ZFF), anterior end (A), and the most protruding point of the zygomatic arch (B). Measurements included IF-PNA, IF-IM, IF-ZFF, ZFF-IM, A-B, and orbital floor depth (OFD). Results: Significant findings showed IF-PNA was greater in males (18.66 ± 2.63 mm, p = 0.001), and IF-ZFF varied between sides (26.72 ± 8.7 mm, p = 0.002). ZFF-IM was larger in males (7.43 ± 2.09 mm, p < 0.001). Heights and thicknesses were also assessed, with significant side differences observed. Conclusions: These findings underscore the importance of understanding precise anatomical distances for successful implant placement. The study provides essential data to enhance surgical planning and training, ensuring safer procedures and minimizing the risk of complications. Full article

Study Design: Retrospective with follow-up. Objective: To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods: Patients with unilateral ZMC fractures between 2007–2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018–2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results: The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions: Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery. Full article

Background: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. Objective: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers (“In-House” reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. Materials and Methods: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais–Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. Results: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the “Magna Graecia” University Hospital of Catanzaro 10 fulfilled the study’s inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm³, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. Conclusion: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient’s anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing. Full article

Enophthalmos is a severe complication of primary reconstruction following orbital floor fractures, oncological resections, or maxillo-facial syndromes. The goal of secondary orbital reconstruction is to regain a symmetrical globe position to restore function and aesthetics. In this article, we present a method of computer-assisted orbital floor reconstruction using a mirroring technique and a custom-made titanium or high-density polyethylene mesh printed using computer-aided manufacturing techniques. This reconstructive protocol involves four steps: mirroring of the healthy orbit computer tomography files at the contralateral affected site, virtual design of a customized implant, computer-assisted manufacturing (CAM) of the implant using Direct Metal Laser Sintering (DMLS) or Computer Numerical Control (CNC) methods, and surgical insertion of the device. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography measures in 13 treated patients and compared to a control group treated with stock implants. An improvement of 3.04 mm (range 0.3–6 mm) in globe protrusion was obtained for the patients treated with patient-specific implants (PSI), and no major complications have been registered. The technique described here appears to be a viable method for correcting complex orbital floor defects needing delayed reconstruction. Full article

Study Design: N/A. Objective: This study investigated the different ways of orbital floor reconstruction with special focus on reconstruction materials, imaging modalities (intra-/ post-operative), 3D printing and navigation. Methods: The heads of all governmental-run or associated cranio-maxillofacial surgery units in Switzerland, Austria and Germany were asked in person or received an email link for an online survey with 12 questions. Results: The return rate was 57%. The most often selected number of reconstructions was between 10 and 50 per year. Resorbable polydioxanone (PDS) foils (41%) and titanium mesh (18 %) were most often used to reconstruct the orbital floor. 31% use 3D Navigation intraoperative. Post-operative imaging was most often performed with CBCT (34.5%) in patients without complications, whereas CT scans were most often performed (63.3%) in patients with persisting complications. In total, 27% stated that they never use preformed orbital plates, and the remaining units use them more or less regularly. 48% have access to a 3D printer and 75% of the respondents use patient specific implants. Conclusions: The majority of the participating units prefer to use resorbablematerial for the reconstruction of the orbital floor defects. 3D printing facilities are not available in the majority of units, but it can be expected that the number of units with 3D printing facilities will rise in the near future. Full article

Purpose: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. Methods: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. Results: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601–0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451–1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. Conclusion: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times. Full article

The integration of functional biomaterials in oculoplastic and orbital surgery is a pivotal area where material science and clinical practice converge. This review, encompassing primary research from 2015 to 2023, delves into the use of biomaterials in two key areas: the reconstruction of orbital floor fractures and the development of implants and prostheses for anophthalmic sockets post-eye removal. The discussion begins with an analysis of orbital floor injuries, including their pathophysiology and treatment modalities. It is noted that titanium mesh remains the gold standard for orbital floor repair due to its effectiveness. The review then examines the array of materials used for orbital implants and prostheses, highlighting the dependence on surgeon preference and experience, as there are currently no definitive guidelines. While recent innovations in biomaterials show promise, the review underscores the need for more clinical data before these new materials can be widely adopted in clinical settings. The review advocates for an interdisciplinary approach in orbital surgery, emphasizing patient-centered care and the potential of biomaterials to significantly enhance patient outcomes. Full article

Background: Little attention has been paid to combined orbital floor and medial wall fractures with the involvement of the inferomedial orbital strut. Managing this particular fracture can prove challenging. However, various innovative techniques have been introduced to assist with the process. Our study focuses on sharing our approach to orbital wall reconstruction using navigation guidance and titanium-reinforced porous polyethylene plates, specifically cases involving the inferomedial orbital strut. We believe that implementing a navigation system can effectively lead surgeons to the fracture site with utmost safety. Also, we hypothesized that this navigation system is beneficial to use singe fan titanium-reinforced porous polyethylene plates with orbital wall fractures involving IOS while minimizing possible complications. Methods: We retrospectively reviewed 131 patients with medial orbital wall and orbital floor fractures with or without combined other facial bone fractures who underwent orbital wall reconstruction by a single surgeon from May 2021 to May 2023. Amongst, we identified fourteen orbital wall fractures involving the inferomedial orbital strut. We used a subciliary incision as the only approach method for performing titanium-reinforced porous polyethylene plates for navigation-guided orbital wall reconstruction. Patients were followed up for at least three months. Results: All cases were effectively resolved using titanium-reinforced porous polyethylene plates. There were no complications during the patient’s complete recovery, confirmed clinically and radiologically. Based on the serial CT results, it was discovered that implanted titanium-reinforced porous polyethylene plates successfully covered the defect. Conclusion: Based on our retrospective analysis, it has been determined that among the 131 recorded cases of orbital fractures, 14 of them (or 10.7%) involved the inferomedial orbital strut. Navigation-guided reduction using titanium-reinforced porous polyethylene (TR-PPE) plates can lead to predictable, reliable, and excellent outcomes for treating orbital fractures involving the inferomedial orbital strut without complications. Full article