Abstract
Purpose
Patient-specific implants (PSIs) are known to yield reliable outcomes in orbital wall fracture reconstruction (high precision, smoother operating techniques, and shorter surgical duration). This study analyzed the surgical error and clinical and esthetic outcomes of orbital reconstructions with PSIs.
Methods
This ambispective cohort study enrolled patients who underwent orbital reconstruction using PSIs between October 2016 and January 2018. The study endpoints were surgical error, indication and duration of surgery, long-term sequelae, revision surgeries, and surgical complications. Surgical error was analyzed by superimposing the postoperative implant position onto the preoperative virtual plan. Both qualitative (heat map) and quantitative (distance) measurements were obtained.
Results
Three patients were enrolled prospectively and 23 were enrolled retrospectively. Indications for surgery were defect size (25 patients), diplopia (10 patients), impaired eye motility (4 patients), and significant enophthalmos (6 patients). At the last patient visit, there were 5 cases of diplopia, 1 case of exophthalmos, and 6 cases of slight enophthalmos of incremental degree. In terms of surgical error, a mean distance of 0.6 mm (95% CI 0.49−0.76), with mean maximal distance of 3.4 mm (95% CI 2.79−4.02), was noted. No revision surgery was necessary. Lid malposition complications were not observed. However, 1 case each of symblepharon and scleral show were observed. No time-saving component was observed.
Conclusion
PSI use in orbital reconstruction guarantees a preplanned 3D anatomical shape with a mean surgical error of just 0.6mm. Our clinical results were similar to those of other protocols; however, warranting a complex 3D anatomical shape also in large orbital fractures with a low mean surgical error is feasible by using PSI.
Blumer, Michael