Improved Outcomes of Orbital Reconstruction with Intraoperative Imaging and Rapid Prototyping

Publication date: Available online 12 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Edward Nguyen, Jamie Lockyer, Jason Erasmus, Christopher Lim

Abstract

Purpose

Rapid prototyping and intra-operative CT is increasingly employed in orbital reconstruction where placement of implants is indicated and accurate anatomic restoration is mandatory. The purpose of this study was to review the outcomes of orbital reconstructions at a single institution, and the influence of intraoperative CT and rapid prototyping on the rate of return to theatre.

Methods and Materials

A retrospective cohort analysis was performed between 2013 and 2016 to assess whether the use of rapid prototyping and intraoperative imaging were employed, and the need for further revision surgery. Clinical notes were reviewed and data collected for patient sex, age, fracture pattern, pre-operative diplopia and enophthalmos. It was also noted whether the use of rapid prototyping and intraoperative imaging were employed, the number of 'spins' required, plating systems, post-operative diplopia and enophthalmos, restoration of orbital form and the need for further surgical intervention. Patients were excluded if no orbital implants were inserted, or if they were lost to follow up.

Results

Three-hundred and thirty-one cases of orbital trauma were reviewed. There were 248 male and 83 female patients. The age range of orbital trauma was 7 to 96, with a mean age of 37.5 years. A total of 154 orbital reconstructions were performed between 2013 and 2016. Five cases required a return to theatre for implant revision. All 5 cases did not utilise intraoperative imaging (p=0.0016), and 4 did not have a rapid prototype biomodel (p=0.006). A total 25 out of 110 cases (22.7%) utilizing intraoperative CT required intraoperative revision.

Conclusion

The present study demonstrates improved outcomes for patients treated for orbital fractures when intraoperative imaging and rapid prototyping biomodelling was utilized. As a result, post-operative imaging and the morbidity of revision surgery can be avoided. These technologies should be available and be considered a standard of care to any surgeon performing reconstruction of orbital fractures.

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