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Virtual Surgical Planning for Orbital Reconstruction.

Susarla SM, Duncan K, Mahoney NR, Merbs SL, Grant MP - Middle East Afr J Ophthalmol (2015 Oct-Dec)

Bottom Line: The advent of computer-assisted technology has revolutionized planning for complex craniofacial operations, including orbital reconstruction.Orbital reconstruction is ideally suited for virtual planning, as it allows the surgeon to assess the bony anatomy and critical neurovascular structures within the orbit, and plan osteotomies, fracture reductions, and orbital implant placement with efficiency and predictability.The surgeon managing orbital pathology and posttraumatic orbital deformities can benefit immensely from utilizing virtual planning for various types of orbital pathology.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

ABSTRACT
The advent of computer-assisted technology has revolutionized planning for complex craniofacial operations, including orbital reconstruction. Orbital reconstruction is ideally suited for virtual planning, as it allows the surgeon to assess the bony anatomy and critical neurovascular structures within the orbit, and plan osteotomies, fracture reductions, and orbital implant placement with efficiency and predictability. In this article, we review the use of virtual surgical planning for orbital decompression, posttraumatic midface reconstruction, reconstruction of a two-wall orbital defect, and reconstruction of a large orbital floor defect with a custom implant. The surgeon managing orbital pathology and posttraumatic orbital deformities can benefit immensely from utilizing virtual planning for various types of orbital pathology.

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Related in: MedlinePlus

Three-dimensional and axial computed tomography, as used for operative planning for a displaced orbitozygomatic fracture. In the preoperative images (top panels), the displaced zygoma (top left) was repositioned by mirroring the left zygoma and virtually positioning the mirrored bone (top middle and top right panels). The postoperative images (bottom panels) demonstrate anatomic alignment of the zygomatic articulations and reconstruction of the orbital floor
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Figure 3: Three-dimensional and axial computed tomography, as used for operative planning for a displaced orbitozygomatic fracture. In the preoperative images (top panels), the displaced zygoma (top left) was repositioned by mirroring the left zygoma and virtually positioning the mirrored bone (top middle and top right panels). The postoperative images (bottom panels) demonstrate anatomic alignment of the zygomatic articulations and reconstruction of the orbital floor

Mentions: ZMC fractures sometimes termed zygoma fractures or orbitozygomatic fractures, are among the most common type of facial fracture.78910 High-or low-energy mechanisms can disrupt the articulations of the zygomatic bone with the frontal bone (frontozygomatic suture), temporal bone (zygomatic arch), sphenoid bone (sphenozygomatic suture), and maxilla (zygomaticomaxillary buttress). The 3D relationship between these articulations was not initially understood in the management of these injuries, which were commonly referred to as “tripod” fractures. Advances in CT have improved the understanding of these injuries and the complex 3D anatomy that needs to be restored for successful management.78910111213 Restoration of the sphenozygomatic articulation in the lateral orbit remains the most reliable predictor of a successful reduction but is difficult to assess without surgical access to the internal orbit.712272829 Furthermore, management of the orbital floor remains controversial among patients with ZMC fractures.2829 The use of real-time imaging (mini C-arm, CT) has allowed for assessment of anatomic alignment and orbital floor integrity following reduction, improving operating times and decreasing patient morbidity from unnecessary orbital exploration.13202123 In the case presented, an orbitozygomatic fracture was repaired utilizing virtual planning to establish the appropriate position of the right zygoma. To accomplish this, the left zygoma complex was digitally rendered from a 3D CT reconstruction and subsequently mirrored and placed onto the right midface [Figure 3]. The reconstituted virtual position of the zygoma served as a template and was then used to guide intra-operative positioning of the displaced fracture. Virtual planning also allowed for visualization of the sizable orbital floor defect, which required orbital exploration and reconstruction using an anatomical plate.


Virtual Surgical Planning for Orbital Reconstruction.

Susarla SM, Duncan K, Mahoney NR, Merbs SL, Grant MP - Middle East Afr J Ophthalmol (2015 Oct-Dec)

Three-dimensional and axial computed tomography, as used for operative planning for a displaced orbitozygomatic fracture. In the preoperative images (top panels), the displaced zygoma (top left) was repositioned by mirroring the left zygoma and virtually positioning the mirrored bone (top middle and top right panels). The postoperative images (bottom panels) demonstrate anatomic alignment of the zygomatic articulations and reconstruction of the orbital floor
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660529&req=5

Figure 3: Three-dimensional and axial computed tomography, as used for operative planning for a displaced orbitozygomatic fracture. In the preoperative images (top panels), the displaced zygoma (top left) was repositioned by mirroring the left zygoma and virtually positioning the mirrored bone (top middle and top right panels). The postoperative images (bottom panels) demonstrate anatomic alignment of the zygomatic articulations and reconstruction of the orbital floor
Mentions: ZMC fractures sometimes termed zygoma fractures or orbitozygomatic fractures, are among the most common type of facial fracture.78910 High-or low-energy mechanisms can disrupt the articulations of the zygomatic bone with the frontal bone (frontozygomatic suture), temporal bone (zygomatic arch), sphenoid bone (sphenozygomatic suture), and maxilla (zygomaticomaxillary buttress). The 3D relationship between these articulations was not initially understood in the management of these injuries, which were commonly referred to as “tripod” fractures. Advances in CT have improved the understanding of these injuries and the complex 3D anatomy that needs to be restored for successful management.78910111213 Restoration of the sphenozygomatic articulation in the lateral orbit remains the most reliable predictor of a successful reduction but is difficult to assess without surgical access to the internal orbit.712272829 Furthermore, management of the orbital floor remains controversial among patients with ZMC fractures.2829 The use of real-time imaging (mini C-arm, CT) has allowed for assessment of anatomic alignment and orbital floor integrity following reduction, improving operating times and decreasing patient morbidity from unnecessary orbital exploration.13202123 In the case presented, an orbitozygomatic fracture was repaired utilizing virtual planning to establish the appropriate position of the right zygoma. To accomplish this, the left zygoma complex was digitally rendered from a 3D CT reconstruction and subsequently mirrored and placed onto the right midface [Figure 3]. The reconstituted virtual position of the zygoma served as a template and was then used to guide intra-operative positioning of the displaced fracture. Virtual planning also allowed for visualization of the sizable orbital floor defect, which required orbital exploration and reconstruction using an anatomical plate.

Bottom Line: The advent of computer-assisted technology has revolutionized planning for complex craniofacial operations, including orbital reconstruction.Orbital reconstruction is ideally suited for virtual planning, as it allows the surgeon to assess the bony anatomy and critical neurovascular structures within the orbit, and plan osteotomies, fracture reductions, and orbital implant placement with efficiency and predictability.The surgeon managing orbital pathology and posttraumatic orbital deformities can benefit immensely from utilizing virtual planning for various types of orbital pathology.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

ABSTRACT
The advent of computer-assisted technology has revolutionized planning for complex craniofacial operations, including orbital reconstruction. Orbital reconstruction is ideally suited for virtual planning, as it allows the surgeon to assess the bony anatomy and critical neurovascular structures within the orbit, and plan osteotomies, fracture reductions, and orbital implant placement with efficiency and predictability. In this article, we review the use of virtual surgical planning for orbital decompression, posttraumatic midface reconstruction, reconstruction of a two-wall orbital defect, and reconstruction of a large orbital floor defect with a custom implant. The surgeon managing orbital pathology and posttraumatic orbital deformities can benefit immensely from utilizing virtual planning for various types of orbital pathology.

Show MeSH
Related in: MedlinePlus