title: Orbital Reconstruction: Patient-Specific Orbital Floor Reconstruction Using a Mirroring Technique and a Customized Titanium Mesh.
abstract: OBJECTIVE
  Enophthalmos is a severe complication of primary reconstruction of orbital floor fractures. The goal of secondary reconstruction procedures is to restore symmetrical globe positions to recover function and aesthetics. The authors propose a new method of orbital floor reconstruction using a mirroring technique and a customized titanium mesh, printed using a direct metal laser-sintering method.
  
  
  METHODS
  This reconstructive protocol involves 4 steps: mirroring of the healthy orbit at the affected site, virtual design of a patient-specific orbital floor mesh, CAM procedures for direct laser-sintering of the customized titanium mesh, and surgical insertion of the device. Using a computed tomography data set, the normal, uninjured side of the craniofacial skeleton was reflected onto the contralateral injured side, and a reconstructive orbital floor mesh was designed virtually on the mirrored orbital bone surface. The solid-to-layer files of the mesh were then manufactured using direct metal laser sintering, which resolves the shaping and bending biases inherent in the indirect method. An intraoperative navigation system ensured accuracy of the entire procedure.
  
  
  RESULTS
  Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography data in 7 treated patients.
  
  
  CONCLUSIONS
  The technique described here appears to be a viable method to correct complex orbital floor defects needing delayed reconstruction. This study represents the first step in the development of a wider experimental protocol for orbital floor reconstruction using computer-assisted design-computer-assisted manufacturing technology.
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Achille
authors.initials: A
authors.lastname: Tarsitano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Badiali
authors.forename: Angelo
authors.initials: A
authors.lastname: Pizzigallo
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
mesh_terms: D017076:Computer-Aided Design; D015841:Enophthalmos / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D009917:Orbital Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D014025:Titanium; D014057:Tomography, X-Ray Computed / Q000379:methods; D015050:Zygoma / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D014025:Titanium