title: Preformed vs intraoperative bending of titanium mesh for orbital reconstruction.
abstract: OBJECTIVE
  The most accurate orbital reconstructions result from an anatomic repair of the premorbid orbital architecture. Many different techniques and materials have been used; unfortunately, there is currently no optimal method. This study compares the use of preformed vs intraoperative bending of titanium mesh for orbital reconstruction in 2-wall orbital fractures.
  
  
  METHODS
  Cadaver-based study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Preinjury computed tomography scans were obtained in 15 cadaveric heads (30 orbits). Stereolithographic (STL) models were fabricated for 5 of the specimens (10 orbits). Two wall fractures (lamina papyracea and floor) were then generated in all orbits. Surgical reconstruction was performed in all orbits using 1 of 3 techniques (10 orbits each): (1) patient-specific implant molded from the preinjury STL model, (2) titanium mesh sheet bent freehand, and (3) preformed titanium mesh. Each technique was evaluated for orbital volume correction, contour accuracy, ease of use, and cost.
  
  
  RESULTS
  No difference in volume restoration was found between the 3 techniques. Patient-specific implants had the greatest contour accuracy, poor ease of use, and highest cost. Freehand bending implants had the poorest contour accuracy, acceptable ease of use, and lowest cost. Preformed mesh implants had intermediate contour accuracy, excellent ease of use, and low cost.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, University of California, Davis, California 95817, USA. edward.strong@ucdmc.ucdavis.edu
authors.forename: E Bradley
authors.initials: EB
authors.lastname: Strong
authors.forename: Scott C
authors.initials: SC
authors.lastname: Fuller
authors.forename: David F
authors.initials: DF
authors.lastname: Wiley
authors.forename: Janina
authors.initials: J
authors.lastname: Zumbansen
authors.forename: M D
authors.initials: MD
authors.lastname: Wilson
authors.forename: Marc C
authors.initials: MC
authors.lastname: Metzger
mesh_terms: D001860:Bone Plates; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008422:Materials Testing; D009917:Orbital Fractures / Q000473:pathology / Q000601:surgery*; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D013526:Surgical Mesh; D014025:Titanium
chemical_list: D014025:Titanium
keywords: computer software; facial fracture; facial reconstruction; facial trauma; fracture; orbit; orbital reconstruction; orbital trauma; orbital volume; trauma; volume analysis