Utilizing 3D-Printed Orbital Floor Stamps to Create Patient-Specific Implants for Orbital Floor Reconstruction

Abstract

Purpose: This study seeks to test a novel technique of custom-printed midface contour models with orbital floor “stamps” to guide reconstruction of orbital floor blowout fractures, with or without concomitant zygomaticomaxillary complex injury. Methods: A series of 4 consecutive patients with orbital floor blowout fractures (including 3 with zygomatic maxillary complex fractures) were retrospectively examined for outcomes associated with orbital floor reconstruction using 3-dimensional–printed stamps and midface models. Data collected included demographics, pre- and postoperative visual globe malposition, motility, and visual field disturbances. Three-dimensional printing methodology is reported, as well as associated costs and time required to generate the models and stamps. Results: The cost of producing a midface-contour model and orbital floor stamps was $131, inclusive of labor and materials. Cases averaged 170 minutes to segment, design, and print. Patients with preoperative diplopia and motility restrictions had resolution of their symptoms. Two patients had resolution of their enophthalmos, while one patient with a concomitant zygomaticomaxillary fracture had persistent mild enophthalmos. Conclusions: Midface contour models and orbital floor stamps may be produced in a timely and cost-effective manner. Use of these “homemade” stamps allows for patient-specific custom-contoured orbital floor reconstruction. Further studies are warranted to examine long-term visual and esthetic outcomes for these patients.

Towards Precision Ophthalmology: The Role of 3D Printing and Bioprinting in Oculoplastic Surgery, Retinal, Corneal, and Glaucoma Treatment

“…Current investigations into 3D printing technology explore its viability for crafting personalized orbital implants, with a significant body of research focusing on utilizing 3D models for implant customization [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] and for the creation of directly printed implants [ 45 , 46 , 47 , 48 , 49 , 50 ]. Chai et al (2021) demonstrated the efficacy of using patient-specific 3D-printed models as templates for intraoperative adjustments to implants, noting a marked decrease in both surgery duration and related complications [ 32 ].…”

“…Finally, a 3D-printed pressing apparatus designed to press a real implant between two 3D models of the implant is explored. Rather than the surgeon cutting or molding the implant, they hold and press the apparatus to obtain a ready-to-use personalized implant [ 41 , 42 ]. Though not directly compared to 3D-printed templates or molds, this technique shows excellent outcomes through quantitative [ 42 ] and qualitative [ 41 ] measures.…”

“…Rather than the surgeon cutting or molding the implant, they hold and press the apparatus to obtain a ready-to-use personalized implant [ 41 , 42 ]. Though not directly compared to 3D-printed templates or molds, this technique shows excellent outcomes through quantitative [ 42 ] and qualitative [ 41 ] measures. However, these pressing apparatuses were only evaluated in small sample sizes.…”

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

“…To account for this issue, we developed positive and negative molds of the orbital floor to stamp the plate to achieve higher fidelity in our implants. 2 In addition, we have found that heat-activated poly- d -lactic acid implants were more easily able to achieve a perfect contour of the mirrored orbital floor model. We initially confirmed fidelity of these stamped implants within an orbital model; however, with experience, we found that this step could be omitted, and we have since used stamps in isolation (Fig.…”

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

“…We greatly appreciate the interest in our article 1 and the response by Mr. Prabhu and Dr. Runyan. In their letter and a recently published article, 2 they describe the use of molds with which titanium orbital fixation plates can be shaped. Using both positive and negative molds of the orbital floor, they compress the plate and, much like an industrial manufacturing machine, stamp it into the desired shape.…”