Endoscopically assisted computer-guided repair of internal orbital floor fractures: an updated protocol for minimally invasive management

Tel, Alessandro; Sembronio, Salvatore; Costa, Fabio; Stenico, Alessandro; Bagatto, Daniele; D’Agostini, Serena; Robiony, Massimo

doi:10.1016/j.jcms.2019.11.005

Cited by 22 publications

(21 citation statements)

References 21 publications

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“…Our planning approach consists in the preliminary definition of two interrelated elements, namely, the transmaxillary portal, which identifies the opening on the anterior wall of the maxillary sinus, and the transorbital portal, represented by the osteotomy on the orbital floor, which provides access into the intraorbital compartment. Our strategy is to design such portals with the same size, allowing to use the anterior maxillary wall to reconstruct the orbital floor in the eventuality that the original orbital floor breaks during the osteotomy phase, a method that our group has already described for the endoscopic transmaxillary treatment of internal orbital floor fractures ( 12 ). Compared with traditional transcutaneous incisions, this approach provides several advantages, including the absence of visible scars, an almost direct vision of the orbital floor up to the orbital apex, which can be further improved using a 30° optics, and, as mentioned, it makes autogenous bone available for orbital floor reconstruction, if needed.…”

Section: Discussionmentioning

confidence: 99%

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit—Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality

et al. 2021

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In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.

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Section: Discussionmentioning

confidence: 99%

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit—Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality

et al. 2021

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“…Oh et al reported successful outcomes without complication in 104 patients [ 82 ]. Tel et al described 14 orbital floor fractures repaired via a transmaxillary endoscopic approach with CT-guided 3D prints used to fit autologous bone into the defects [ 71 ].…”

Section: Methodsmentioning

confidence: 99%

3D Printing in Eye Care

2021

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Three-dimensional printing enables precise modeling of anatomical structures and has been employed in a broad range of applications across medicine. Its earliest use in eye care included orbital models for training and surgical planning, which have subsequently enabled the design of custom-fit prostheses in oculoplastic surgery. It has evolved to include the production of surgical instruments, diagnostic tools, spectacles, and devices for delivery of drug and radiation therapy. During the COVID-19 pandemic, increased demand for personal protective equipment and supply chain shortages inspired many institutions to 3D-print their own eye protection. Cataract surgery, the most common procedure performed worldwide, may someday make use of custom-printed intraocular lenses. Perhaps its most alluring potential resides in the possibility of printing tissues at a cellular level to address unmet needs in the world of corneal and retinal diseases. Early models toward this end have shown promise for engineering tissues which, while not quite ready for transplantation, can serve as a useful model for in vitro disease and therapeutic research. As more institutions incorporate in-house or outsourced 3D printing for research models and clinical care, ethical and regulatory concerns will become a greater consideration. This report highlights the uses of 3D printing in eye care by subspecialty and clinical modality, with an aim to provide a useful entry point for anyone seeking to engage with the technology in their area of interest.

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“…The authors' article "Endoscopically Assisted Computer-Guided Repair of Internal Orbital Floor Fractures: An Updated Protocol for Minimally Invasive Management," 7 was first place global winner at the Mimics Innovation Awards 2020 by Materialise (Leuven, Belgium).…”

Section: Disclosurementioning

confidence: 99%

“…Moreover, the authors did not consider our article describing a protocol for an entirely transantral endoscopic repair of internal orbital floor fractures using virtual surgical planning 7 ; it avoids stereolithographic skull models, titanium mesh, and external access, thereby further reducing costs as well as complications related to mesh infection and transcutaneous approaches, such as scarring, ectropion, and entropion (Fig. 2).…”

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confidence: 99%

Low-Cost, Three-Dimensionally–Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction

Tel¹,

Sembronio²,

Costa³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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The authors report a consolidated methodology, which consists of mirroring the unaffected orbital side over the injured orbital floor with subsequent threedimensional printing of the mirrored model, although in our experience this step might be misleading. In virtual surgical planning, we tend to avoid mirroring; instead, we try to reproduce the ideal shape of the orbital floor to harmonize the reconstruction with the surrounding orbital geometry (Fig. 1). Moreover, even the contralateral uninjured orbital floor may appear discontinuous in a three-dimensional reconstruction, because of the partial-volume computed tomography artifact, which affects thin structures. In fact, appropriate three-dimensional reconstruction of the orbital floor is the core of many research studies on virtual surgical planning in orbital traumatology, 5 and the authors did not suggest how to deal with this issue.The authors did not evaluate intraoperative accuracy, as the article focuses only on prebending a titanium mesh. Conversely, it would be important to perform intraoperative navigation using the virtual orbital floor reconstruction as a virtual template to avoid any implant misplacement, which may frequently occur, especially across the posterior border of the fracture. Prebending is an outdated concept in the era of additive manufacturing and custom-made devices, which provide state-of-the-art accuracy in orbital floor reconstruction. On the other hand, since personalized implants are expensive, the authors might consider preformed plates, now available in large sets with different shapes and sizes, including IPS Implants' midface orbita (KLS Martin, Tuttlingen, Germany). The choice of the appropriate implant can be made based on a virtual library, evaluating which one best fits the practical dicing method. The design of two insulin injectors with 15 blades is an original solution that has not been seen before. 1 This was a preliminary study of my ultra-diced cartilage grafting technique. Further details and studies are shared in my upcoming book. 2 In addition, many practical surgical maneuvers, including the ultra-diced cartilage grafting technique, are shared in my course, 3 which is organized annually.

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Endoscopically assisted computer-guided repair of internal orbital floor fractures: an updated protocol for minimally invasive management

Cited by 22 publications

References 21 publications

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit—Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit—Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality

3D Printing in Eye Care

Low-Cost, Three-Dimensionally–Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction

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