Using 3D Printing and Mirror Image Modeling in Orbital Floor Reconstruction

Abstract

Three-dimensional (3D) modeling and printing technologies are increasingly utilized as tools to assist in complex craniofacial reconstructions. Herein, the authors report the intraoperative use of sterilized 3D models printed in-house to mold a custom resorbable implant in the case of a pediatric patient with a unilateral complex orbital fracture. The imaging was processed with opensource software. Two patient-specific orbital models were 3Dprinted (Fig. 2): a life-size print of the patient's preoperative CT scan and a left orbit reconstructed to resemble its uninjured state using mirrored-imaging of the uninjured side. This construct ultimately served as a sterilized template to mold a resorbable implant intraoperatively. Post-operatively, the patient experienced no complications. At the 18-month follow-up, the patient had done well without diplopia, headaches or visual problems. The authors report a case of a successful orbit reconstruction assisted by mirrored-image computer modeling and patient-specific 3D printing.

The Use and Outcomes of 3D Printing in Pediatric Craniofacial Surgery: A Systematic Review

“…This included no randomized controlled trials or nonrandomized intervention trials but included 3 case series [20][21][22] and 4 case reports. [23][24][25][26] All articles were published between January 2017 and December 2022, and were available in English. The included studies are described in Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/SCS/F800.…”

“…22 The individual case studies each described a patient with a frontoethmoidal meningoencephalocele, 23 a complex craniofacial cleft with hypertelorism, 24 an orbital fracture, 25 and a cranial intraosseous lipoma. 26 3DP was used in preoperative planning with the creation of mock surgical models in 2 studies, 23,24 used to create custom intraoperative cutting guides or molds in 6 studies, [20][21][22][24][25][26] and used to create custom cranioplasty implants in 2 studies. 24,26 The specific technology and materials used in the 3DP process were described in most of the included studies (Supplemental Table 2, Supplemental Digital Content 2, http://links.lww.com/ SCS/F801).…”

“…24,26 The specific technology and materials used in the 3DP process were described in most of the included studies (Supplemental Table 2, Supplemental Digital Content 2, http://links.lww.com/ SCS/F801). Several studies reported that 3DP was performed "inhouse" or within the institution, 21,25 while the other studies did not specify the location of the performed printing. 20,[22][23][24]26 No studies directly specified that industry intermediaries were used for printing.…”

Pediatric orbital fractures

“…Chai et al [51] published a pediatric case series wherein patient-specific 3D CT reconstruction models were used to help adapt the resorbable implant preoperatively, which reduced operative time. A case report by Akiki et al [52 ▪ ] similarly demonstrated the use of a 3D template to mold a resorbable implant to address an orbital floor and medial wall fracture in a pediatric patient. Although patient-specific implants (PSIs) have gained popularity in adult populations, their use in pediatrics is limited.…”

Virtual Planning and 3D Printing in the Management of Acute Orbital Fractures and Post-Traumatic Deformities

“…At the 18 months' follow-up, the authors reported no complications and normal eye projection. 16 Three-dimensionally printed PSIs and models have been shown to be anatomically accurate. Schön et al demonstrated that PSIs were accurate within a 1-mm range on postoperative CT scan.…”