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Semin Plast Surg 2022; 36(03): 149-157
DOI: 10.1055/s-0042-1754387
Review Article

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

Basel Sharaf
1   Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
,
Daniel E. Leon
1   Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
,
Lilly Wagner
2   Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
,
Jonathan M. Morris
3   Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, Minnesota
,
Cristina A. Salinas
1   Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract

Virtual surgical planning (VSP) and three-dimensional (3D) printing have advanced surgical reconstruction of orbital defects. Individualized 3D models of patients' orbital bony and soft tissues provide the surgeon with corrected orbital volume based on normalized anatomy, precise location of critical structures, and when needed a better visualization of the defect or altered anatomy that are paramount in preoperative planning. The use of 3D models preoperatively allows surgeons to improve the accuracy and safety of reconstruction, reduces intraoperative time, and most importantly lowers the rate of common postoperative complications, including over- or undercontouring of plates, orbital implant malposition, enophthalmos, and hypoglobus. As 3D printers and materials become more accessible and cheaper, the utility of printing patient-specific implants becomes more feasible. This article summarizes the traditional surgical management of orbital fractures and reviews advances in VSP and 3D printing in this field. It also discusses the use of in-house (point-of-care) VSP and 3D printing to further advance care of acute orbital trauma and posttraumatic deformities.

Keywords

virtual surgical planning - three-dimensional printing - orbital fracture - orbital reconstruction - point-of-care


Publication History

Article published online:
07 December 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Shui W, Zhou M, Chen S. et al. The production of digital and printed resources from multiple modalities using visualization and three-dimensional printing techniques. Int J CARS 2017; 12 (01) 13-23
    Google Scholar
  • 2 Sharaf B, Kuruoglu D, Cantwell SR, Alexander AE, Dickens HJ, Morris JM. EPPOCRATIS: expedited preoperative point-of-care reduction of fractures to normalized anatomy and three-dimensional printing to improve surgical outcomes. Plast Reconstr Surg 2022; 149 (03) 695-699
    CrossrefPubMedGoogle Scholar
  • 3 Holmes S. Primary orbital fracture repair. Atlas Oral Maxillofac Surg Clin North Am 2021; 29 (01) 51-77
    CrossrefPubMedGoogle Scholar
  • 4 Grob S, Yonkers M, Tao J. Orbital fracture repair. Semin Plast Surg 2017; 31 (01) 31-39
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Alinasab B, Beckman MO, Pansell T, Abdi S, Westermark AH, Stjärne P. Relative difference in orbital volume as an indication for surgical reconstruction in isolated orbital floor fractures. Craniomaxillofac Trauma Reconstr 2011; 4 (04) 203-212
    CrossrefPubMedGoogle Scholar
  • 6 Bianchi F, De Haller R, Steffen H, Courvoisier DS, Scolozzi P. Does vertical incomitance predict the diplopia outcome in orbital fracture patients? A prospective study of 188 patients. J Craniomaxillofac Surg 2019; 47 (02) 305-310
    CrossrefPubMedGoogle Scholar
  • 7 Dal Canto AJ, Linberg JV. Comparison of orbital fracture repair performed within 14 days versus 15 to 29 days after trauma. Ophthal Plast Reconstr Surg 2008; 24 (06) 437-443
    CrossrefPubMedGoogle Scholar
  • 8 Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions. Clin Ophthalmol 2015; 9: 2127-2137
    Google Scholar
  • 9 Vasile VA, Istrate S, Iancu RC. et al. Biocompatible materials for orbital wall reconstruction-an overview. Materials (Basel) 2022; 15 (06) 2183
    CrossrefPubMedGoogle Scholar
  • 10 Ellis III E, Tan Y. Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh. J Oral Maxillofac Surg 2003; 61 (04) 442-453
    CrossrefPubMedGoogle Scholar
  • 11 Hammer B, Prein J. Correction of post-traumatic orbital deformities: operative techniques and review of 26 patients. J Craniomaxillofac Surg 1995; 23 (02) 81-90
    CrossrefPubMedGoogle Scholar
  • 12 Gear AJ, Lokeh A, Aldridge JH, Migliori MR, Benjamin CI, Schubert W. Safety of titanium mesh for orbital reconstruction. Ann Plast Surg 2002; 48 (01) 1-7 , discussion 7–9
    CrossrefPubMedGoogle Scholar
  • 13 Sugar AW, Kuriakose M, Walshaw ND. Titanium mesh in orbital wall reconstruction. Int J Oral Maxillofac Surg 1992; 21 (03) 140-144
    CrossrefPubMedGoogle Scholar
  • 14 Sharma N, Welker D, Aghlmandi S. et al. A multi-criteria assessment strategy for 3D printed porous polyetheretherketone (PEEK) patient-specific implants for orbital wall reconstruction. J Clin Med 2021; 10 (16) 3563
    CrossrefPubMedGoogle Scholar
  • 15 Chepurnyi Y, Chernogorskyi D, Kopchak A, Petrenko O. Clinical efficacy of peek patient-specific implants in orbital reconstruction. J Oral Biol Craniofac Res 2020; 10 (02) 49-53
    CrossrefPubMedGoogle Scholar
  • 16 Akiki RK, Jehle CC, Crozier J, Woo AS. Using 3D printing and mirror image modeling in orbital floor reconstruction. J Craniofac Surg 2021; 32 (07) 2465-2467
    CrossrefPubMedGoogle Scholar
  • 17 Schön R, Metzger MC, Zizelmann C, Weyer N, Schmelzeisen R. Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures. Int J Oral Maxillofac Surg 2006; 35 (11) 990-995
    CrossrefPubMedGoogle Scholar
  • 18 Blumer M, Essig H, Steigmiller K, Wagner ME, Gander T. Surgical outcomes of orbital fracture reconstruction using patient-specific implants. J Oral Maxillofac Surg 2021; 79 (06) 1302-1312
    CrossrefPubMedGoogle Scholar
  • 19 Ma CY, Wang TH, Yu WC. et al. Accuracy of the application of 3-dimensional printing models in orbital blowout fractures-a preliminary study. Ann Plast Surg 2022; 88 (1s, Suppl 1) S33-S38
    CrossrefPubMedGoogle Scholar
  • 20 Nikunen M, Rajantie H, Marttila E, Snäll J. Implant malposition and revision surgery in primary orbital fracture reconstructions. J Craniomaxillofac Surg 2021; 49 (09) 837-844
    Google Scholar
  • 21 Mims MM, Wang EW. Cost analysis of implants in the surgical repair of orbital floor fractures. Ann Otol Rhinol Laryngol 2020; 129 (05) 456-461
    CrossrefPubMedGoogle Scholar
  • 22 Schlittler F, Vig N, Burkhard JP, Lieger O, Michel C, Holmes S. What are the limitations of the non-patient-specific implant in titanium reconstruction of the orbit?. Br J Oral Maxillofac Surg 2020; 58 (09) e80-e85
    CrossrefPubMedGoogle Scholar
  • 23 Kitabata R, Uno K, Sakamoto Y. Reconstruction of combined orbital floor and medial wall fractures using custom-made titanium alloy implant. J Craniofac Surg 2021; 32 (04) e388-e389
    CrossrefPubMedGoogle Scholar
  • 24 Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging applications of bedside 3D printing in plastic surgery. Front Surg 2015; 2: 25
    PubMedGoogle Scholar
  • 25 Callahan AB, Campbell AA, Petris C, Kazim M. Low-cost 3D printing orbital implant templates in secondary orbital reconstructions. Ophthal Plast Reconstr Surg 2017; 33 (05) 376-380
    CrossrefPubMedGoogle Scholar
  • 26 Girotto JA, Gamble WB, Robertson B. et al. Blindness after reduction of facial fractures. Plast Reconstr Surg 1998; 102 (06) 1821-1834
    CrossrefPubMedGoogle Scholar
  • 27 Cheon JS, Seo BN, Yang JY, Son KM. Retrobulbar hematoma in blow-out fracture after open reduction. Arch Plast Surg 2013; 40 (04) 445-449
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Kim JM. Retrobulbar hematoma following the repair of an orbital wall fracture: a case series. Maxillofac Plast Reconstr Surg 2021; 43 (01) 8
    CrossrefPubMedGoogle Scholar
  • 29 Putterman AM, Stevens T, Urist MJ. Nonsurgical management of blow-out fractures of the orbital floor. Am J Ophthalmol 1974; 77 (02) 232-239
    CrossrefPubMedGoogle Scholar
  • 30 Burnstine MA. Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis. Ophthalmology 2002; 109 (07) 1207-1210 , discussion 1210–1211, quiz 1212–1213
    CrossrefPubMedGoogle Scholar
  • 31 Alinasab B, Borstedt KJ, Rudström R. et al. New algorithm for the management of orbital blowout fracture based on prospective study. Craniomaxillofac Trauma Reconstr 2018; 11 (04) 285-295
    CrossrefPubMedGoogle Scholar
  • 32 Choi A, Sisson A, Olson K, Sivam S. Predictors of delayed enophthalmos after orbital fractures: a systematic review. Facial Plast Surg Aesthet Med 2022; 24 (05) 397-403
    CrossrefPubMedGoogle Scholar
  • 33 He Y, Zhang Y, An JG. Correlation of types of orbital fracture and occurrence of enophthalmos. J Craniofac Surg 2012; 23 (04) 1050-1053
    CrossrefPubMedGoogle Scholar
  • 34 Dvoracek LA, Lee JY, Unadkat JV. et al. Low-cost, three-dimensionally-printed, anatomical models for optimization of orbital wall reconstruction. Plast Reconstr Surg 2021; 147 (01) 162-166
    CrossrefPubMedGoogle Scholar
  • 35 Hatz CR, Msallem B, Aghlmandi S, Brantner P, Thieringer FM. Can an entry-level 3D printer create high-quality anatomical models? Accuracy assessment of mandibular models printed by a desktop 3D printer and a professional device. Int J Oral Maxillofac Surg 2020; 49 (01) 143-148
    CrossrefPubMedGoogle Scholar
  • 36 Andrades P, Cuevas P, Hernández R, Danilla S, Villalobos R. Characterization of the orbital volume in normal population. J Craniomaxillofac Surg 2018; 46 (04) 594-599
    CrossrefPubMedGoogle Scholar
  • 37 Gosau M, Schöneich M, Draenert FG, Ettl T, Driemel O, Reichert TE. Retrospective analysis of orbital floor fractures–complications, outcome, and review of literature. Clin Oral Investig 2011; 15 (03) 305-313
    CrossrefPubMedGoogle Scholar
  • 38 Oh TS, Jeong WS, Chang TJ, Koh KS, Choi JW. Customized orbital wall reconstruction using three-dimensionally printed rapid prototype model in patients with orbital wall fracture. J Craniofac Surg 2016; 27 (08) 2020-2024
    CrossrefPubMedGoogle Scholar
  • 39 Jadhav C, Cunneen S. Three-dimensional printing technology for medial orbital wall fractures. J Craniofac Surg 2015; 26 (08) e799-e800
    CrossrefPubMedGoogle Scholar
  • 40 Lor LS, Massary DA, Chung SA, Brown PJ, Runyan CM. Cost analysis for in-house versus industry-printed skull models for acute midfacial fractures. Plast Reconstr Surg Glob Open 2020; 8 (05) e2831
    CrossrefPubMedGoogle Scholar
  • 41 Vatankhah R, Emadzadeh A, Nekooei S. et al. 3D printed models for teaching orbital anatomy, anomalies and fractures. J Ophthalmic Vis Res 2021; 16 (04) 611-619
    PubMedGoogle Scholar