Computer-Assisted Secondary Orbital Reconstruction

Daman D Singh; Lara Schorn; E Bradley Strong; Michael Grant; Alexander Schramm; Karsten Hufendiek; Nils-Claudius Gellrich; Majeed Rana

doi:10.1177/1943387520935004

Computer-Assisted Secondary Orbital Reconstruction

Craniomaxillofac Trauma Reconstr. 2021 Mar;14(1):29-35. doi: 10.1177/1943387520935004. Epub 2020 Jul 9.

Authors

Daman D Singh¹, Lara Schorn¹, E Bradley Strong², Michael Grant³, Alexander Schramm⁴, Karsten Hufendiek⁵, Nils-Claudius Gellrich⁵, Majeed Rana¹

Affiliations

¹ Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
² Department of Otolaryngology, University of California Davis School of Medicine, Sacramento, CA, USA.
³ Plastic and Reconstructive Surgery at the R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
⁴ Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Ulm, Ulm, Germany.
⁵ Department of Oral-, Maxillo- and Plastic Facial Surgery, University of Hannover, Hannover, Germany.

Abstract

Study design: This study presents a case-control study of 33 patients who underwent secondary orbital reconstruction, evaluating techniques and outcome.

Objective: Adequate functional and aesthetical appearance are main goals for secondary orbital reconstruction. Insufficient premorbid orbital reconstruction can result in hypoglobus, enophthalmos, and diplopia. Computer-assisted surgery and the use of patient-specific implants (PSIs) is widely described in the literature. The authors evaluate the use of selective laser-melted PSIs and hypothesize that PSIs are an excellent option for secondary orbital reconstruction.

Methods: The sample was composed of 33 patients, previously treated with primary orbital reconstruction, presenting themselves with indications for secondary reconstruction (i.e. enophthalmos, diplopia, or limited eye motility). Computed tomography and/or cone beam data sets were assessed before and after secondary reconstruction comparing intraorbital volumes, infraorbital angles, and clinical symptoms. Clinical outcomes were assessed using a standardized protocol.

Results: Results show a significant change in intraorbital volumes and a reduction of clinical symptoms after secondary reconstruction.

Conclusions: Outcomes of this study suggest that secondary orbital reconstruction can be performed routinely using selective laser-melted PSIs and titanium spacers.

Keywords: computer-assisted surgery; diplopia; enophthalmos; orbital reconstruction; patient-specific implant; selective laser melting; three-dimensional mesh.