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The use of modern imaging techniques in the diagnosis and treatment planning of patients with orbital floor fractures.

Loba P, Kozakiewicz M, Elgalal M, Stefańczyk L, Broniarczyk-Loba A, Omulecki W - Med. Sci. Monit. (2011)

Bottom Line: Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section.A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant.Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical University of Lodz, University Hospital No 1, Lodz, Poland. ploba@onet.pl

ABSTRACT

Background: Ocular motility impairment associated with orbital trauma may have several causes and manifest with various clinical symptoms. In some cases orbital reconstructive surgery can be very challenging and the results are often unsatisfactory. The use of modern imaging techniques aids proper diagnosis and surgical planning.

Case report: The authors present the case of a 29-year-old male who sustained trauma to the left orbit. Orthoptic examination revealed limited supra- and infraduction of the left eye. The patient reported diplopia in upgaze and downgaze with primary position spared. Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section. A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant. The patient underwent reconstructive surgery of the orbital floor.

Conclusions: Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment.

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Related in: MedlinePlus

Modeling and application of custom implant. (A) Virtual model undergoing symmetry analysis. Green color indicates left-right symmetrical surfaces within tolerance ±1 mm. Asterix indicates the most unsymmetrical region of orbital wall, area of destruction [dark grey color indicates that points are not within the range of symmetry]. (B) Rapid prototyping anatomical model in the operating theatre. Model created using the mirroring technique, represents the original “pre-morbid” shape of the injured lower orbital wall. Custom implant (0.4 mm titanium mesh) formed on the basis of the re-established anatomical relations. (C) Intra-operative view showing a transconjunctival approach. Trapdoor type fracture and the depressed lower orbital wall can be seen after reduction of herniated inferior rectus muscle [asterix] (D) Custom implant located within the orbit and covering the bone defect in the lower orbital wall. It is stabilized by screws that are fixed to the lower orbital margin.
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f4-medscimonit-17-8-cs94: Modeling and application of custom implant. (A) Virtual model undergoing symmetry analysis. Green color indicates left-right symmetrical surfaces within tolerance ±1 mm. Asterix indicates the most unsymmetrical region of orbital wall, area of destruction [dark grey color indicates that points are not within the range of symmetry]. (B) Rapid prototyping anatomical model in the operating theatre. Model created using the mirroring technique, represents the original “pre-morbid” shape of the injured lower orbital wall. Custom implant (0.4 mm titanium mesh) formed on the basis of the re-established anatomical relations. (C) Intra-operative view showing a transconjunctival approach. Trapdoor type fracture and the depressed lower orbital wall can be seen after reduction of herniated inferior rectus muscle [asterix] (D) Custom implant located within the orbit and covering the bone defect in the lower orbital wall. It is stabilized by screws that are fixed to the lower orbital margin.

Mentions: Due to the fact that a restrictive factor was found to be responsible for ocular motility impairment, the patient was qualified for orbital reconstructive surgery. The surgery was performed under general anesthesia. The left lower orbital wall was reached by transconjunctival approach and herniated tissues were reduced. The implanted alloplastic material was titanium mesh and rapid-prototyping was implemented to create an individual anatomical model. This was built on the basis of a 3-dimensional multislice computed tomography (MSCT) scan of the intact orbit (GE Lightspeed VCT). Titanium mesh 0.4 mm in thickness [KLS Martin Group, Germany] was shaped and cut to size using the anatomical model to achieve a 3-D shape that best fitted the contours of the orbit (floor) (Figure 4).


The use of modern imaging techniques in the diagnosis and treatment planning of patients with orbital floor fractures.

Loba P, Kozakiewicz M, Elgalal M, Stefańczyk L, Broniarczyk-Loba A, Omulecki W - Med. Sci. Monit. (2011)

Modeling and application of custom implant. (A) Virtual model undergoing symmetry analysis. Green color indicates left-right symmetrical surfaces within tolerance ±1 mm. Asterix indicates the most unsymmetrical region of orbital wall, area of destruction [dark grey color indicates that points are not within the range of symmetry]. (B) Rapid prototyping anatomical model in the operating theatre. Model created using the mirroring technique, represents the original “pre-morbid” shape of the injured lower orbital wall. Custom implant (0.4 mm titanium mesh) formed on the basis of the re-established anatomical relations. (C) Intra-operative view showing a transconjunctival approach. Trapdoor type fracture and the depressed lower orbital wall can be seen after reduction of herniated inferior rectus muscle [asterix] (D) Custom implant located within the orbit and covering the bone defect in the lower orbital wall. It is stabilized by screws that are fixed to the lower orbital margin.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539610&req=5

f4-medscimonit-17-8-cs94: Modeling and application of custom implant. (A) Virtual model undergoing symmetry analysis. Green color indicates left-right symmetrical surfaces within tolerance ±1 mm. Asterix indicates the most unsymmetrical region of orbital wall, area of destruction [dark grey color indicates that points are not within the range of symmetry]. (B) Rapid prototyping anatomical model in the operating theatre. Model created using the mirroring technique, represents the original “pre-morbid” shape of the injured lower orbital wall. Custom implant (0.4 mm titanium mesh) formed on the basis of the re-established anatomical relations. (C) Intra-operative view showing a transconjunctival approach. Trapdoor type fracture and the depressed lower orbital wall can be seen after reduction of herniated inferior rectus muscle [asterix] (D) Custom implant located within the orbit and covering the bone defect in the lower orbital wall. It is stabilized by screws that are fixed to the lower orbital margin.
Mentions: Due to the fact that a restrictive factor was found to be responsible for ocular motility impairment, the patient was qualified for orbital reconstructive surgery. The surgery was performed under general anesthesia. The left lower orbital wall was reached by transconjunctival approach and herniated tissues were reduced. The implanted alloplastic material was titanium mesh and rapid-prototyping was implemented to create an individual anatomical model. This was built on the basis of a 3-dimensional multislice computed tomography (MSCT) scan of the intact orbit (GE Lightspeed VCT). Titanium mesh 0.4 mm in thickness [KLS Martin Group, Germany] was shaped and cut to size using the anatomical model to achieve a 3-D shape that best fitted the contours of the orbit (floor) (Figure 4).

Bottom Line: Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section.A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant.Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical University of Lodz, University Hospital No 1, Lodz, Poland. ploba@onet.pl

ABSTRACT

Background: Ocular motility impairment associated with orbital trauma may have several causes and manifest with various clinical symptoms. In some cases orbital reconstructive surgery can be very challenging and the results are often unsatisfactory. The use of modern imaging techniques aids proper diagnosis and surgical planning.

Case report: The authors present the case of a 29-year-old male who sustained trauma to the left orbit. Orthoptic examination revealed limited supra- and infraduction of the left eye. The patient reported diplopia in upgaze and downgaze with primary position spared. Dynamic magnetic resonance imaging (dMRI) was performed, which revealed restriction of the left inferior rectus muscle in its central section. A patient-specific anatomical model was prepared on the basis of 3-dimensional computed tomography (CT) study of the intact orbit, which was used to prepare a custom pre-bent titanium mesh implant. The patient underwent reconstructive surgery of the orbital floor.

Conclusions: Modern imaging techniques such as dMRI and 3-dimensional CT reconstruction allow us to better understand the pathophysiology of orbital floor fractures and to precisely plan surgical treatment.

Show MeSH
Related in: MedlinePlus