title: Navigation-aided reconstruction of medial orbital wall and floor contour in cranio-maxillofacial reconstruction.
abstract: The reconstruction of the anterio-posterior inclination of the medial aspect of the orbital floor, despite a wide 360 degrees exposure, including coronal and conjunctival incisions, is a challenging task in severe injuries of the orbit with massive comminution and complete displacement of the medial orbital wall and orbital floor. Out of a total of 20 patients with orbital fractures, five underwent a surgical intervention of repositioning the medial aspect of the orbital floor and especially the transition area between the orbital floor and medial orbital wall, using navigation-aided procedures. Using the mirroring tool of the Stryker-Leibinger STN-system, post-operative CTs indicated an average difference of the globe position of -4.9% between the operated side and the unaffected side, depending on the position of the medial aspect of the orbital floor. Navigation-aided procedures proved to be an essential precondition for achieving precise and predictable results in orbital reconstruction. In such cases, unlike those with an intact medial orbital wall remnant as a surgical target, bone grafts for reconstruction of the orbital floor cannot be implanted as onlay grafts.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany. kloesel@zmk2.ukl.uni-freiburg.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzeisen
authors.forename: Nils Claudius
authors.initials: NC
authors.lastname: Gellrich
authors.forename: Ralf
authors.initials: R
authors.lastname: Schoen
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutwald
authors.forename: Christoph
authors.initials: C
authors.lastname: Zizelmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Schramm
mesh_terms: D000328:Adult; D015841:Enophthalmos / Q000209:etiology / Q000601:surgery; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D009915:Orbit / Q000601:surgery*; D009917:Orbital Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D014056:Tomography, X-Ray / Q000379:methods; D016896:Treatment Outcome