title: Digital surgical templates for managing high-energy zygomaticomaxillary complex injuries associated with orbital volume change: a quantitative assessment.
abstract: OBJECTIVE
  This study sought to introduce 3-dimensional (3D) virtual surgical planning and digital rapid-prototyping templates for zygomaticomaxillary complex (ZMC) injuries associated with orbital volume change and to evaluate the surgical outcomes quantitatively.
  
  
  METHODS
  Eight patients who underwent open reduction and fixation for a ZMC injury with orbital volume change were studied. Computed tomographic (CT) scan of the zygomaticomaxillary area was performed before the operation in each case. Scanned data were converted into 3D models using Mimics software (Materialise, Brussels, Belgium) for surgical designs. Virtual surgical reductions and correlated guiding templates were designed using Mimics and Magics software (Materialise). The operations were performed with the help of prefabricated templates to reduce the fractures. A postoperative CT scan of each patient was obtained within 2 weeks after surgery, and quantitative measurements were made to assess the surgical outcomes. Preoperative volumes of the bilateral orbits were compared, and concordance with postoperative volumes of the bilateral orbits was assessed. Twenty-one pairs of distances from 7 marker points to 3 reference planes were measured to assess postoperative facial symmetry.
  
  
  RESULTS
  Volumes of the injured orbits were significantly different from volumes of the uninjured orbits preoperatively (P < .05), whereas bilateral orbital volumes showed no statistically significant difference postoperatively (P > .05). In addition, 19 of the 21 pairs of bilateral distances showed no significant difference postoperatively (P > .05).
  
  
  CONCLUSIONS
  Quantitative assessment showed that digitally designed, rapid-prototyping templates for ZMC fractures have a positive impact on restoring facial symmetry and concordance of bilateral orbital volumes.
authors.affiliation: Attending, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiang-Zhen
authors.initials: XZ
authors.lastname: Liu
authors.forename: Da-Long
authors.initials: DL
authors.lastname: Shu
authors.forename: Wei
authors.initials: W
authors.lastname: Ran
authors.forename: Bing
authors.initials: B
authors.lastname: Guo
authors.forename: Xin
authors.initials: X
authors.lastname: Liao
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D002508:Cephalometry / Q000379:methods; D017076:Computer-Aided Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008440:Maxillary Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D008953:Models, Anatomic; D009915:Orbit / Q000000981:diagnostic imaging; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D009929:Organ Size; D010347:Patient Care Planning; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface; D055815:Young Adult; D015051:Zygomatic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*