Improved Outcomes of Orbital Reconstruction With Intraoperative Imaging and Rapid Prototyping

Rapid prototyping and intraoperative computed tomography (CT) are increasingly used in orbital reconstruction when placement of implants is indicated and accurate anatomic restoration is mandatory. The purpose of this study was to review the outcomes of orbital reconstructions at a single institution and the influence of intraoperative CT and rapid prototyping on the rate of return to the operating theater.

A retrospective cohort analysis was performed from 2013 through 2016 to assess whether rapid prototyping and intraoperative imaging were used and the need for further revision surgery. Clinical notes were reviewed and data were collected for patient gender, age, fracture pattern, preoperative diplopia, and enophthalmos. Also noted were whether rapid prototyping and intraoperative imaging were used, the number of "spins" required, plating systems, postoperative diplopia and enophthalmos, restoration of orbital form, and the need for further surgical intervention. Patients were excluded if no orbital implants were inserted or if they were lost to follow-up.

Three hundred thirty-one cases of orbital trauma were reviewed (248 male and 83 female patients; age range, 7 to 96 yr; mean age, 37.5 yr). In total, 154 orbital reconstructions were performed from 2013 through 2016. Five cases required a return to the operating theater for implant revision. All 5 cases did not use intraoperative imaging (P = .0016), and 4 did not have a rapid prototype bio-model (P = .006). Twenty-five of 110 cases (22.7%) using intraoperative CT required intraoperative revision.

The present study shows improved outcomes for patients treated for orbital fractures when intraoperative imaging and rapid prototyping bio-modeling are used. As a result, postoperative imaging and the morbidity of revision surgery can be avoided. These technologies should be available and considered standard of care to any surgeon performing reconstruction of orbital fractures.