Management of recurrent pneumo‐orbit secondary to post traumatic sino‐orbital fistula using a navigation‐guided customised 3D printed titanium implant: a case report and review of literature

Abstract

Introduction: Chronic persistent pneumo-orbital fistula is a rare complication of orbital trauma with only four previously reported cases in English literature, all of which were present after surgical repair of the orbital fracture and all of them were treated by removal of the orbital implant and cauterisation of the herniated tissues. Case presentation: We present an interesting case of recurrent left pneumo-orbit secondary to untreated traumatic large inferomedial sinoorbital fistula which was successfully repaired using a customised titanium Patient Specific Implant (PSI) inserted with assistance from a navigation system. The thin implant ensured there was no alteration of globe position or diplopia. To the best of the authors knowledge, this is the first reported case in the English literature to describe closure of active, persistent chronic pneumo-orbital fistula using this novel technique.This article will explore this approach and discuss its limitations based on our experience and a review of the existing literature regarding different causes,presentations, complications, treatment and approaches for the management of pneumo-orbitum. Conclusion: The use of a solid PSI is an effective and safe treatment for the closure of persistent sino-orbital fistula and should be considered as a viable treatment option in this group of patients. CASE PRESENTATION Presentation and findingsA 48-year-old Caucasian Male was referred to the multidisciplinary orbital trauma clinic, run jointly