Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstruction

Schreurs, Ruud; Klop, Cornelis; Gooris, Peter J.J.; Maal, T.J.J.; Becking, A.G.; Dubois, L.

doi:10.1016/j.ijom.2021.08.027

Cited by 6 publications

(10 citation statements)

References 45 publications

(69 reference statements)

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“…This overview is not comprehensive, and novel design options are regularly introduced in the literature. Posterior to bulbus [49] Orbital floor elevated in sagittal relation Amount [22] Based on clinical findings, advanced diagnostics [38] Slight overcorrection [50] Eccentric screw alters implant position [47] Fix implant if form stable [40] Fixation re-use Accuracy Re-used screw hole [54] Only in secondary reconstruction Multi-piece Positioning, stability, Lazy-S [42,47,49] accuracy Interlocking [46,48,55,56] Design considerations can be categorized based on their intended effect: stability, positioning ease, accuracy of implant positioning or alleviation of clinical symptoms. The size and shape of the implant are dependent on the extent of the defect.…”

Section: Patient-specific Implant Designmentioning

confidence: 99%

“…Support on existing bony structures is taken into account to ensure the stability of the reconstruction. Analogous to the preformed implants, support is most often found at three points in the orbit [22,38]. Fixation is recommended to ensure a stable position of the PSI [39,40].…”

Section: Patient-specific Implant Designmentioning

confidence: 99%

“…This technology-supported workflow, called computer-assisted surgery (CAS), has become the standard for complex orbital traumatology in many hospitals [22]. The introduction of CAS has also enabled personalization of the treatment: treatment planning is customized to fit the options and needs of the patient, and intraoperative guidance is adjusted to the anatomical possibilities.…”

Section: Introductionmentioning

confidence: 99%

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Personalized Medicine Workflow in Post-Traumatic Orbital Reconstruction

Sabelis

Schreurs

Essig

et al. 2022

JPM

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Restoration of the orbit is the first and most predictable step in the surgical treatment of orbital fractures. Orbital reconstruction is keyhole surgery performed in a confined space. A technology-supported workflow called computer-assisted surgery (CAS) has become the standard for complex orbital traumatology in many hospitals. CAS technology has catalyzed the incorporation of personalized medicine in orbital reconstruction. The complete workflow consists of diagnostics, planning, surgery and evaluation. Advanced diagnostics and virtual surgical planning are techniques utilized in the preoperative phase to optimally prepare for surgery and adapt the treatment to the patient. Further personalization of the treatment is possible if reconstruction is performed with a patient-specific implant and several design options are available to tailor the implant to individual needs. Intraoperatively, visual appraisal is used to assess the obtained implant position. Surgical navigation, intraoperative imaging, and specific PSI design options are able to enhance feedback in the CAS workflow. Evaluation of the surgical result can be performed both qualitatively and quantitatively. Throughout the entire workflow, the concepts of CAS and personalized medicine are intertwined. A combination of the techniques may be applied in order to achieve the most optimal clinical outcome. The goal of this article is to provide a complete overview of the workflow for post-traumatic orbital reconstruction, with an in-depth description of the available personalization and CAS options.

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Section: Patient-specific Implant Designmentioning

confidence: 99%

Section: Patient-specific Implant Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Personalized Medicine Workflow in Post-Traumatic Orbital Reconstruction

Sabelis

Schreurs

Essig

et al. 2022

JPM

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“…Schreurs et al demonstrated improved postoperative outcomes in enophthalmos, diplopia, and hypoglobus with the use of PSIs. 27 Custom-made implants in delayed cases can be helpful in providing a patient-specific volumetric repair of the orbital fractures and to correct enophthalmos. However, timing in creation of custom-made implants can be variable and potentially costly.…”

Section: Surgical Managementmentioning

confidence: 99%

Management of Posttraumatic Enophthalmos Including Complex Secondary Deficits

Gengler

Hsieh

2022

Facial Plast Surg

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Posttraumatic enophthalmos (PE) arises when the ocular globe is displaced posteriorly and inferiorly in the orbital cavity due to a mismatch in orbital volume and orbital content. This most commonly happens after orbital fractures. The resulting disruptions to aesthetic form and ocular functions often necessitate surgical correction for reconstruction and restoration. The purpose of surgical management of PE is to reconstruct orbital shape and volume as well as to restore any herniated orbital content. This can be particularly challenging in cases involving large defects that require complex orbital reconstruction. Recent advancements in computer-aided surgery have introduced innovative and important tools to assist surgeons with these difficult cases. The ability to create customized, patient-specific implants can facilitate reconstruction involving complicated anatomy. Additionally, intraoperative imaging and intraoperative navigation can serve as useful guides for surgeons to more accurately place implants, especially in cases with limited visualization, in order to achieve optimal outcomes.

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“…Flat implants, however, might not be appropriate in circumstances where the orbital walls are depressed or have uneven forms. (17,18) The intricate and complex 3D morphologies with restricted intraoperative vision and no conventional implant fixation site make reconstructing complex orbital fractures involving numerous wall fractures with posterior edge and inferior orbital rim abnormalities difficult. Because titanium mesh can be fixed rigidly with screws, so it is the implant which is of choice in this scenario.…”

Section: Introductionmentioning

confidence: 99%

Orbital Defect Reconstruction using Customized Implants: Current Techniques and Long-Term Outcomes in Maxillofacial Surgery.

Muñoz,

Zapata,

Guerrero

et al. 2024

ijmsdh

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This systematic review investigates the current methods and long-term results of maxillofacial surgery orbital defect restoration with personalized implants. PRISMA standards were followed in order to identify and analyze pertinent studies that focused on patient-specific implants (PSI) for orbital abnormalities. This was accomplished by a thorough search of multiple databases. The findings demonstrate how well PSI works to improve both functional and cosmetic outcomes, such as the correction of facial asymmetries, enophthalmos, and diplopia. Surgical navigation and 3D printing are examples of cutting-edge technology that have improved orbital defect reconstruction's precision and versatility. While some research points to a trend toward better results when using PSI as opposed to more conventional methods, additional long-term data is required to properly assess its effectiveness. The analysis highlights the role that customized implants play in attaining the best possible outcomes and urges more research to improve surgical methods and assess patient outcomes over long time frames.

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Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstruction

Cited by 6 publications

References 45 publications

Personalized Medicine Workflow in Post-Traumatic Orbital Reconstruction

Personalized Medicine Workflow in Post-Traumatic Orbital Reconstruction

Management of Posttraumatic Enophthalmos Including Complex Secondary Deficits

Orbital Defect Reconstruction using Customized Implants: Current Techniques and Long-Term Outcomes in Maxillofacial Surgery.

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