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Three-Dimensional Reconstruction of Orbital Fractures
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The Use of Patient-Specific Orbital Reconstruction Implants During Maxillectomy Reconstruction
Dipan D Desai1, Mohamedkazim Alwani1, Derek Sheen1
1Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
Facial Plastic Surgery & Aesthetic Medicine
|March 1, 2023
Summary
Patient-specific orbital reconstruction implants (PSORI) effectively reconstruct the orbital floor after maxillectomy. Modified implant designs and surgical approaches significantly reduce complications like diplopia and hardware extrusion.
Area of Science:
- Oral and Maxillofacial Surgery
- Oculoplastic Surgery
- Reconstructive Surgery
Background:
- Maxillectomy for tumor removal can lead to significant functional and aesthetic issues in orbital floor reconstruction.
- Reconstruction aims to restore form and function, minimizing patient morbidity.
Purpose of the Study:
- To evaluate eyelid position, visual outcomes, and complications.
- To assess the efficacy of patient-specific orbital reconstruction implants (PSORI) in concurrent maxillectomy and reconstruction.
Main Methods:
- A case series of 12 patients undergoing orbital floor reconstruction with PSORI after tumor extirpation.
- Data collected included diplopia, ectropion, wound healing, and hardware complications.
- Free flap reconstruction, primarily fibula flaps, was used in most cases.
Main Results:
- Three patients (25%) experienced long-term complications (diplopia, hardware extrusion), particularly after total maxillectomy and radiation.
- Subsequent use of a modified implant design and midface-degloving approach eliminated extrusions in later patients.
- Median follow-up was 415.5 days.
Conclusions:
- PSORIs are viable for orbital floor reconstruction post-maxillectomy with free tissue transfer.
- Implant design and surgical approach are crucial for minimizing complications.
- A modified, low-profile implant design with a midface-degloving approach yielded favorable outcomes.
