Orbital Remodeling and 3-dimensional Printing in Delayed Orbital Floor Fracture Reconstructions

The mechanism and physiology of orbital cavity remodeling after orbital fractures is not well described. This poses a challenge in the delayed operative treatment of orbital floor fractures due to variations from expected anatomy and may risk injury to critical structures during exploration as well as misguided reconstruction, causing persistent ocular dystopia. We report a case where significant orbital remodeling caused unexpected challenges to orbital floor reconstruction, highlighting the need for further research in this field. A 23-year-old previously healthy man was treated conservatively for a left orbital floor fracture sustained during a rugby match. At a 4-month follow-up, the patient was found to have significant ocular dystopia with vertical diplopia and cosmetically significant enophthalmos. A discrepancy of 4 mm was noted on exophthalmometry. Intraoperatively, the neo-floor was found to have fully healed but with significant downsloping angulation and clinically appreciable depression. Furthermore, no fracture ledges were able to be used to guide the height of the titanium reconstruction plate, posing a significant challenge. Therefore, a 3-dimensional printed model of the orbit using a recent computed tomography scan was used to conform the plate to the required dimensions. The patient made a good recovery without ocular symptoms. Fracture remodeling of the orbital cavity is poorly described and may not be considered in the delayed treatment of orbital fractures. Further research to describe the mechanism and pattern of how this occurs is necessary. Computer-assisted design with 3-dimensional printing is a useful tool that can help overcome technical challenges in complex maxillofacial cases.