Is there more to the clinical outcome in posttraumatic reconstruction of the inferior and medial orbital walls than accuracy of implant placement and implant surface contouring? A prospective multicenter study to identify predictors of clinical outcome

Publication date: Available online 1 February 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ruediger M. Zimmerer, Nils-Claudius Gellrich, Sophie von Bülow, Strong Brad, Edward Ellis, Maximilian E.H. Wagner, Gregorio Sanchez Aniceto, Alexander Schramm, Michael P. Grant, Chye Lim Thiam, Alvaro Rivero Calle, Frank Wilde, Daniel Perez, Gido Bittermann, Nicholas R. Mahoney, Marta Redondo Alamillos, Joanna Bašić, Marc Metzger, Michael Rasse, Jan Dittman, Elke Rometsch, Kathrin Espinoza, Ronny Hesse, Carl-Peter Cornelius
PurposeReconstruction of orbital wall fractures is demanding and has improved dramatically with the implementation of new technologies. True-to-original accuracy of reconstruction has been deemed essential for good clinical outcome, and reasons for unfavorable clinical outcome have been researched extensively. However, no detailed analysis on the influence of plate position and surface contour on clinical outcome has yet been published.Materials and MethodsData from a previous study were used for an ad-hoc analysis to identify predictors for unfavorable outcome, defined as diplopia or differences in globe height and/or globe projection of >2 mm. Presumed predictors were implant surface contour, aberrant implant dimension or position, accuracy of reconstructed orbital volume, and anatomical fracture topography according to the current AO classification.ResultsNeither in univariable nor in multivariable regression models were unfavorable clinical outcomes associated with any of the presumed radiological predictors, and no association of the type of implant, i.e., standard preformed, CAD-based individualized and non−CAD-based individualized with its surface contour could be shown.ConclusionThese data suggest that the influence of accurate mechanical reconstruction on clinical outcomes may be less predictable than previously believed, while the role of soft-tissue−related factors may have been underestimated.



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