title: Patient specific implants (PSI) in reconstruction of orbital floor and wall fractures.
abstract: Fractures of the orbital wall and floor can be challenging due to the demanding three-dimensional anatomy and limited intraoperative overview. Misfitting implants and inaccurate surgical technique may lead to visual disturbance and unaesthetic results. A new approach using individually manufactured titanium implants (KLS Martin, Group, Germany) for daily routine is presented in the current paper. Preoperative CT-scan data were processed in iPlan 3.0.5 (Brainlab, Feldkirchen, Germany) to generate a 3D-reconstruction of the affected orbit using the mirrored non-affected orbit as template and the extent of the patient specific implant (PSI) was outlined and three landmarks were positioned on the planned implant in order to allow easy control of the implant's position by intraoperative navigation. Superimposition allows the comparison of the postoperative result with the preoperative planning. Neither reoperation was indicated due to malposition of the implant and the ocular bulb nor visual impairments could be assessed. PSI allows precise reconstruction of orbital fractures by using a complete digital workflow and should be considered superior to manually bent titanium mesh implants.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland. Electronic address: Thomas.Gander@usz.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gander
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Harald
authors.initials: H
authors.lastname: Essig
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lindhorst
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Leander
authors.initials: L
authors.lastname: Dubois
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Rücker
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Schumann
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging; D001672:Biocompatible Materials / Q000737:chemistry; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000601:surgery*; D010347:Patient Care Planning; D066230:Patient-Specific Modeling; D016687:Polydioxanone / Q000737:chemistry; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000379:methods; D013526:Surgical Mesh; D014025:Titanium / Q000737:chemistry; D014057:Tomography, X-Ray Computed / Q000379:methods; D057188:Workflow
chemical_list: D001672:Biocompatible Materials; D016687:Polydioxanone; D014025:Titanium
keywords: Computer-assisted surgery; Orbital fractures; Patient specific implants (PSI); Reconstruction