Preformed vs Intraoperative Bending of Titanium Mesh for Orbital Reconstruction

Strong, E. Bradley; Fuller, Scott C.; Wiley, David F.; Zumbansen, Janina; Wilson, Machelle; Metzger, Marc Christian

doi:10.1177/0194599813481430

Cited by 68 publications

(60 citation statements)

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“…5,6 A recent study by Strong et al reported that this had "the greatest contour accuracy" when compared with freehand bending in cadaveric orbits. 7 However, they also noted that stereolithographic modeling incurred the highest cost. 7 Currently, the price of anatomical models outsourced to medical modeling companies can be considerable.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Prototyping Technology in Orbital Floor Reconstruction: Application in Three Patients

Lim

Campbell

Clucas

2014

Craniomaxillofacial Trauma & Reconstruction

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).Rapid prototyping, also known as three-dimensional (3D) printing, is an additive manufacturing technology that allows expedient and accurate reproduction of osseous anatomy. It was originally introduced in the mechanical engineering field during the 1980s and this technology has gained interest in craniomaxillofacial surgery as a tool for assessment and preoperative surgical planning.1,2 For orbital floor fractures, rapid prototyping can provide an accurate anatomical representation of the osseous defect, allowing the clinician to preoperatively adapt a titanium plate for reconstruction. This theoretically reduces the operative time required, risk of orbital plate malposition, poor anatomical contour, and trauma to soft tissues due to multiple insertions during trimming and adaptation of the titanium orbital plate. We propose that the use of rapid prototyping and preoperative plate adaptation can significantly reduce the operative time taken while improving patient outcome. MethodsComputed tomography (CT) data were processed via an imaging software program (e.g., 3D slicer, Osirix [OsirixPixmeo, Bernex, Geneva, Switzerland]), cropped and then exported as a stereolithographic file (.stl) (►Fig. 1) which was then used for fabrication of a 3D model via 3D printing. CT orbital parameters used were 0.5 mm slice thickness, The titanium orbital plate was sterilized before insertion and intraoperative CT imaging was used to assess final titanium plate position. Case 1A 59-year-old female presented to the maxillofacial outpatient department following a mechanical fall resulting in a left orbital floor fracture. Enophthalmos of 2 mm was present and a CT scan revealed a large floor defect (►Figs. 2 and 3). Diplopia was present on upward gaze. A rapid prototyping model was fabricated and a Synthes titanium orbital plate was further adapted preoperatively. The orbital floor was accessed via a mid-lid approach and the modified titanium orbital plate was inserted. No further adaptation of the plate was required and the time taken from insertion of the plate to final fixation was less than 1 minute, as no further adaptation was necessary. Position was confirmed with an intraoperative CT scan (O-arm, Medtronic [Medtronic, Minneapolis, MN]) (►Figs. 4-6). The patient's diplopia and enophthalmos had resolved 2 weeks postoperatively and no complications were noted at the 6th week follow-up. Keywords► rapid prototyping ► 3D printing ► orbital reconstruction AbstractRapid prototyping entails the fabrication of three-dimensional anatomical models which provide an accurate and cost-effective method to visualize complex anatomical structures. Our unit has been using this to assist in the diagnosis, planning, and preoperative titanium plate adaptation for orbital reconstruction surgery following traumatic injury. The aim of this article is to demonstrate the potential clinical and costsaving benefits of this technology.

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Section: Discussionmentioning

confidence: 99%

“…7 However, they also noted that stereolithographic modeling incurred the highest cost. 7 Currently, the price of anatomical models outsourced to medical modeling companies can be considerable. Rapid prototyping models in the above cases were produced for less than $5 NZD each.…”

Section: Discussionmentioning

confidence: 99%

Rapid Prototyping Technology in Orbital Floor Reconstruction: Application in Three Patients

Lim

Campbell

Clucas

2014

Craniomaxillofacial Trauma & Reconstruction

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“…A cadaver-based study found no significant differences in volume restoration between patient-specific implants (PSI) moulded on a pre-injury stereolithographic model, self-bent titanium meshes, and preformed titanium meshes. 65 Preformed implants may be more advantageous because of versatility and costs. 65 Andrades et al 63 concluded that pre-bent titanium implants are superior in terms of optimal reconstruction in comparison to other implants.…”

Section: Contouringmentioning

confidence: 99%

“…65 Preformed implants may be more advantageous because of versatility and costs. 65 Andrades et al 63 concluded that pre-bent titanium implants are superior in terms of optimal reconstruction in comparison to other implants. In large defects (Jaquiéry III-VI), the implant contour becomes an increasingly important factor for repositioning the globe into a correct position.…”

Section: Contouringmentioning

confidence: 99%

Controversies in orbital reconstruction—III. Biomaterials for orbital reconstruction: a review with clinical recommendations

Dubois

Steenen

Gooris

et al. 2016

International Journal of Oral and Maxillofacial Surgery

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“…The medical software's are capable of obtaining the 3D Computer Aided Design (CAD) model from the DICOM data [10,11]. For the current case study, Materialize MIMICS 18.0 software is used to generate a patient specific medical model.…”

Section: Ct Data To 3d Cad Modelmentioning

confidence: 99%

Benefits of Additive Manufacturing Medical Model in Orbital Floor Reconstruction Surgery: A Case Study

Malyala¹,

Kumar²,

Alwala³

et al. 2017

Surgery

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Journal of Surgery IntroductionAdditive Manufacturing (AM) technology has been started for manufacturing prototypes before 30 years with the name Rapid Prototyping (RP). This technology has evolved from prototypes to fully functional parts in various Industries [1]. The Advantage of this technology is to fabricate any complex geometry easily. AM parts are fabricated with almost zero percent wastage of raw material. As compared to conventional subtractive process, AM process adds material in layers. Addition of material is done till the last layer, where the model is completed [2]. The customized models can be fabricated very easily with this technology, which exactly suits for the medical industry. In medical industry the anatomy differs from patient to patient. The patient specific medical model is obtained using the Computer Tomography (CT) of the patient [3]. The CT data of patient is processed through the medical imaging software, once 3D Computer Aided Design (CAD) model is generated [4]. This data is further used for fabrication of patient specific AM medical model. These AM medical models can be easily fabricated using Fused Deposition Modeling (FDM) technique [5,6]. Since FDM is one of the cost effective processes available in AM. These FDM models also have good mechanical properties. The mock surgeries can be conducted on AM medical model and this information from mock is used for finalizing the steps in the actual surgery [7]. The AM medical model provides flexibility for almost each and every step that is going to be adopted in the actual surgery in advance. MethodologyThe following steps are followed for the current case study, which are shown in (Figure1).CT data Acquisition and Reconstruction: For the current case study the patient underwent scanning by 128 slice CT scanner, with scan parameters of the tube current as 300mA, tube voltage as 130kV and pitch as 1mm [8,9]. The CT data was reconstructed using the reconstruction parameters of slice thickness as 0.6mm, slice increment as 0.3mm and AbstractAdditive Manufacturing (AM) is one of the latest manufacturing processes. AM technology provides patient specific customized physical model, which is almost not achievable by any other technique. AM medical models are best suitable for pre-planning of complex medical surgeries such as reconstruction of the orbital floor which has fractured due to severe craniofacial trauma. Orbital floor is formed by a very thin bone which is often fractured during trauma. Among all the injuries of the craniofacial region, orbital fractures account for about 40 percent. The restoration of the orbit to its pre-traumatic volume and anatomy is one of the most delicate and difficult procedure. However this method which involves multiple try-ins, poses a risk of injury to the important structures within the orbit. AM provides the flexibility to bend, adapt/modify the plate prior to the surgery, which saves the intra-operative surgery time. This also avoids the revision of surgery in some cases. For the current study a patie...

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Preformed vs Intraoperative Bending of Titanium Mesh for Orbital Reconstruction

Abstract: All 3 techniques provide equivalent orbital volume correction. However, preformed mesh implants have many advantages based on contour accuracy, ease of use, and relative cost.

Cited by 68 publications

References 10 publications

Rapid Prototyping Technology in Orbital Floor Reconstruction: Application in Three Patients

Rapid Prototyping Technology in Orbital Floor Reconstruction: Application in Three Patients

Controversies in orbital reconstruction—III. Biomaterials for orbital reconstruction: a review with clinical recommendations

Benefits of Additive Manufacturing Medical Model in Orbital Floor Reconstruction Surgery: A Case Study

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