Evaluation of the Application of Computer-Aided Shape-Adapted Fabricated Titanium Mesh for Mirroring-Reconstructing Orbital Walls in Cases of Late Post-Traumatic Enophthalmos

Zhang, Yi; He, Yang; Zhang, Zhi Yong; An, Jin Gang

doi:10.1016/j.joms.2009.08.029

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 68, Issue 9 , Pages 2070-2075, September 2010

Evaluation of the Application of Computer-Aided Shape-Adapted Fabricated Titanium Mesh for Mirroring-Reconstructing Orbital Walls in Cases of Late Post-Traumatic Enophthalmos

Yi Zhang, MD, PhD, DDS
- Professor, Department of Oral and Maxillofacial Surgery, Peking University, School and Hospital of Stomatology, Beijing, China
- Address correspondence and reprint requests to Dr Zhang: Department of Oral and Maxillofacial Surgery, Peking University, School and Hospital of Stomatology, Haidian District, Beijing 100081, China
Yang He, MD, PhD, DDS
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, Peking University, School and Hospital of Stomatology, Beijing, China
Zhi Yong Zhang, MD, PhD, DDS
- Chief Resident, Department of Oral and Maxillofacial Surgery, Peking University, School and Hospital of Stomatology, Beijing, China
Jin Gang An, MD, PhD, DDS
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University, School and Hospital of Stomatology, Beijing, China

published online 07 June 2010.

Purpose

Computer-aided individually shape-adapted fabricated titanium mesh for the mirroring-reconstruction of the orbit is a promising method for the correction of post-traumatic enophthalmos. The purpose of this study was to evaluate the application of this technique and assess the treatment outcomes.

Patients and Methods

Twenty-one patients with delayed treatment of unilateral impure orbital fracture and post-traumatic enophthalmos were included in this study. Computed tomography–based mirroring-reconstruction images of the orbit were obtained for each individual to fabricate anatomically adaptive titanium mesh by computer-aided design and computer-aided manufacturing techniques. After exposing the areas of orbital defect and reducing the herniated soft tissue, the titanium mesh was inserted to reconstruct the internal orbit with a mean deep extension of 29.33 mm. Measurements were performed to assess the change in the degree of enophthalmos and orbital volume before and after surgery. Paired samples t test and Pearson correlation coefficient were employed for statistical analysis.

Results

Follow-up examinations revealed that the degree of enophthalmos decreased to less than 2 mm in 11 patients, 2 to 4 mm in 9 patients, and remained greater than 7 mm in 1 patient. Statistical analysis revealed that post-traumatic enophthalmos in this series was 4.05 ± 2.02 mm, which was associated with an orbital volume increment of 6.61 ± 3.63 cm³, with a regression formula of enophthalmos = 0.446 × orbital volume increment + 2.406. Orbital reconstruction effected a orbital volume decrease of 4.24 ± 2.41 cm³ and enophthalmos correction of 2.01 ± 1.46 mm, the regression formula being enophthalmos = 0.586 × orbital volume decrease + 0.508. After surgery, the degree of unresolved enophthalmos was 2.03 ± 1.52 mm, and the retained orbital volume expansion was 2.23 ± 2.86 cm³, and the regression formula was enophthalmos = 0.494 × orbital volume expansion + 1.415.

Conclusion

Application of the individual fabricated titanium mesh for orbital reconstruction reduced the trauma-induced orbital volume increment by 65% and corrected 50% of severe late enophthalmos. Additional augmentation of orbital contents was required for further correction. The related treatment parameters were suggested.