ABSTRACT The main aim of orbital fracture reconstruction is to restore the functional and aesthetic components of the eye. However, it is known that surgery for complex three-dimensional anatomy of the orbit is always a challenge. With recent advancements in technology, surgical predictability and outcomes have greatly improved. Several methods for orbital reconstruction surgery have been documented such as virtual surgical planning, intraoperative navigation, intraoperative imaging, and the use of patient-specific implant (PSI). PSI made of titanium can be designed by using a computer-aided design process and manufacturing (CAD-CAM) of CT-scan routinely used during diagnostic imaging. With precise analyses in shape and size followed by personalised implant design, the surgical precision can be alleviated further and at the same time, the surgical duration could be reduced with anticipation of better surgical outcomes. However, meticulous planning needs to be done preoperatively, with the timing of the surgery being an important factor. In the present case, pure orbital blowout fracture primarily treated with a personalised-implant solution derived from 3D-printing technology is described. Both pre-surgical and surgical workflow of this computer-assisted surgical method is elaborated. PSI for primary orbital reconstruction can be regarded as a viable alternative surgical solution including its working timeframe and adherence to the surgical protocol or algorithm.
Orbital Fractures--surgery ; Orbital Implants

The operative treatment of orbital blowout fracture involves restoration of intra-orbital soft tissue and bony structural integrity. In extensive blowout fracture, postoperative edema and subsequent increase of intraoribital pressure may sometimes lead to displace the implant. To prevent postperative displacement of the implant, we tried reinforcing the implant using a buttress consisting of micro-titanium mesh and titanium mesh in 13 cases of extensive orbital blowout fracture, including medical wall fracture (6), inferior wall fracture (5) and inferomedial wall fracture (2). A small thin titanium buttress was inserted beneath the implant at the point where intraorbital pressure was involved maximally. It was usually placed superoinferiorly in a medial wall fracture wall fracture, mediplaterally along th posterior ridge of bony defect in an inferior wall fracture, and anteroposteriorly in an inferomedial wall fracture. No evidence of implant displacement after operation was noted in any cases and this was confirmed by postoperative computed tomographic scan. Also, any complication by a titanium buttress did not occur. Orbital implant reinforcement using a titanium buttress may be an available technique for preventing implant displacement in reconstruction of extensive orbital blowout frature.
Edema ; Orbit* ; Orbital Implants ; Titanium*

The various method have been used in reconstruction of the anophthalmic socket. Dermis-fat graft as an orbital implant is a relatively new approach. Dermis-fat graft restores the volume lost by enucleation, gives additional conjunctival lining and is permanent, with a minimal chance of absorption. Dermis-fat graft was used in reconstruction of an ophthalmic socket in our hospital. We found it successful procedure in case of primary enucleation, because it is permanent and it preserves the conjunctiva.
Absorption ; Conjunctiva ; Orbital Implants ; Transplants*

PURPOSE: To evaluate the early effect of orbital reconstruction with MacroPore(R) by assessment of orbital volume through orbital computed tomography (CT) in cases of orbital wall fracture METHODS: We performed orbital reconstruction with MacroPore(R) in patients with orbital wall fracture smaller than 3 cmx2 cm. Orbital CT was done preoperatively and 6 months postoperatively. We then evaluated the results by measuring the orbital volume through Rapidia 2.8 program. RESULTS: The study comprised 14 patients. The site of fracture was the medial wall in one patient, inferior in seven, and both medial and inferior in six patients. The site of insertion of MacroPore(R) was the medial wall in one patient, inferior in 12, and both medial and inferior walls in one. The mean volume of the affected orbit before operation was 20.23+/-2.78 cm3, that of the unaffected orbit was 18.27+/-2.24 cm3 (p-value=0.000), and the mean volume of the affected orbit after operation was 19.06+/-2.57 cm3, that of the unaffected orbit was 18.06+/-2.24 cm3 (p-value=0.000). The mean enophthalmos before operation was 1.00+/-0.62mm, and after operation was 0.64+/-0.46 mm. The mean difference of orbital volume between the affected and the unaffected orbits before operation was 1.96+/-0.33 cm3, and 1.00+/-0.87 cm3 after operation (p-value=0.000). The mean volume of the affected orbit before operation was 20.23+/-2.77 cm3, and 19.06+/-2.57 cm3 after operation (p-value=0.000). Each cubic centimeter decrement in volume caused a 0.67+/-0.68 mm mean decrease of enophthalmos. CONCLUSIONS: We concluded that MacroPore(R) was safe orbital implant and effective in decreasing the orbital volume at early orbital reconstruction in cases of orbital wall fracture smaller than 3 cmx2 cm through a comparison of orbital volume before and after operation.
Enophthalmos ; Humans ; Orbit ; Orbital Implants

Management of posttraumatic enophthalmos can present as a challenge to the reconstructive surgeon, particularly in cases of late presentation. This article reviews the pertinent anatomy of the orbit, diagnostic modalities, indications for surgery, and surgical approaches as they relate to the treatment of posttraumatic enophthalmos. Internal orbital reconstruction has evolved to an elegant procedure incorporating various biologic or alloplastic implants, including anatomical pre-bent implants. Successful repair of late enophthalmos has been demonstrated in multiple recent studies and is likely related to the precision with which orbital anatomy can be restored.
Enophthalmos ; Orbit ; Orbital Fractures ; Orbital Implants ; Polymethacrylic Acids

To evaluate the degree of fibrovascular ingrowth in hydroxyapatite orbital implant, we performed gadolinium-enhanced T1 weighted magnetic resonance imaging in 10 eyes elapsed 6 months after hydrovyapatite implantation and on 6 eyes at 1, 2, 3, 4, and 6 months after hydroxyapatite implantation, and calcualted the volume of enhanced area. In 10 eyes elapsed 6months after hydroxyapatite implantation, all showed enhancement over 90%(average, 93.6%). In 6 eyes examined at 1, 2, 3, 4, and 6 months after hydroxyapatite implantation, the average percentage of enhanced area was 73.2% at 1 month, 76.0% at 2 months, 80.0% at 3 months, 89.8% at 4 months, and 92.0% at 6 months. the enhanced volume was over 90% at 4 months after the implantation in almost all cases. In hydroxyapatite orbital implantation done by our modified procedures, we suggest that the drilling for peg placement is possible 4 months after the implantation.
Durapatite* ; Magnetic Resonance Imaging* ; Orbit* ; Orbital Implants*

PURPOSE: To evaluate the effect of the synthetic bone glass particulate (BG) on the fibrovascular ingrowth into porous polyethylene orbital implant (PP). METHODS: Forty eight rabbits were divided into 4 groups according to the surgical techniques and implanted materials. One eye was enucleated one eye and PP was implanted in group 1, was eviscerated and PP was implanted in group 2, was enucleated and BG, containing 30% by weight synthetic bone glass particulate, was implanted in group 3, and was eviscerated and BG was implanted in group 4. All implants of each group were assessed by histologic study at the first, second, fourth, and eighth weeks postoperatively. The area of fibrovascular ingrowth was calculated by histologic examination. RESULTS: There were no statistically significant differences in the fibrovascular ingrowth among these groups. A greater number of vessels per unit area and matured fibrous tissue was found in the more outer zone at longer time after implantation, but there was not statistically significant difference among the four groups. CONCLUSIONS: On the basis of this study, the synthetic bone glass particulate did not significantly increase the rate of fibrovascular ingrowth into porous polyethylene orbital implant in rabbits.
Glass* ; Orbit* ; Orbital Implants* ; Polyethylene* ; Rabbits

PURPOSE: To evaluate the safety and efficacy of Medpor(R) SST(TM). The implant is composed of porous polyethylene with a smooth anterior surface with pre-drilled suture tunnels (SST) for attachment of extraocular muscles. METHODS: METHODS: Eight patients undergoing enucleation surgery received the unwrapped Medpor(R) SST(TM) orbital implant between August 2001 and December 2001. For each patient, data was acquired regarding complications, socket appearance and motility. RESULTS: Patients have been followed for 11 to 15 months. Socket healing was uneventful with no evidence of implant extrusion or migration. The socket motilities were better than grade 3 in all cases. The motilities of the prosthesis were grade 2 without peg insertion. CONCLUSIONS: The Medpor(R) SST(TM) orbital implant appears to be safe and to offer advantages over conventional implants.
Humans ; Muscles ; Orbital Implants ; Polyethylene ; Prostheses and Implants ; Sutures

BACKGROUND: Poly-L-lactide materials combined with hydroxyapatite (u-HA /PLLA) have been developed to overcome the drawbacks of absorbable materials, such as radiolucency and comparably less implant strength. This study was designed to evaluate the usefulness of u-HA/PLLA material in the repair of orbital medial wall defects. METHODS: This study included 10 patients with pure medial wall blow-out fractures. The plain radiographs were taken preoperatively, immediately after, and 2 months after surgery. The computed tomography scans were performed preoperatively and 2 months after surgery. Patients were evaluated for ease of manipulation, implant immobility, rigidity and complications with radiologic studies. RESULTS: None of the patients had postoperative complications, such as infection or enophthalmos. The u-HA/PLLA implants had adequate rigidity, durability, and stable position on follow-up radiographic studies. On average, implants were thawed 3.4 times and required 14 minutes of handling time. CONCLUSION: The u-HA/PLLA implants are safe and reliable for reconstruction of orbital medial wall in terms of rigidity, immobility, radiopacity, and cost-effectiveness. These thin yet rigid implants can be useful where wide periosteal dissection is difficult due to defect location or size. Since the u-HA/PLLA material is difficult to manipulate, these implants are not suitable for use in complex 3-dimensional defects.
Absorbable Implants ; Durapatite* ; Enophthalmos ; Follow-Up Studies ; Humans ; Orbit* ; Orbital Fractures ; Orbital Implants ; Postoperative Complications

Purpose: To combine the advantage of porosity and biocompatibility of Biphasic Tricalcium Phosphate implant with Muscle Resection Methodology: Non-randomized, uncontrolled clinical case series Results: No migration or extrusion was observed. With improved muscle resection, socket and prosthesis mobility were noted. (Author)
Human ; Young Adult ; Adolescent ; EYE ENUCLEATION ; PROSTHESIS ; IMPLANTS ; ORBITAL IMPLANTS ; ARTIFICIAL IMPLANTS