ABSTRACT
Introduction: Orbital floor fractures are common within midface fractures. Their management includes restoration of orbital volume and anatomy. However, these procedures could be associated with the mispositioning of implants and inadequate volume restoration. Nowadays medical rapid prototyping, virtual planning (VP), and navigation systems significantly increase the precision of such procedures. Nevertheless, the application of intraoperative navigation could be associated with intraoperative mistakes related to two-dimensional imaging. The application of mixed reality (MR) could solve this problem. The current study aims to demonstrate the application of MR in orbital reconstruction. Materials and Methods: The current study included experimental and clinical implementation of MR in orbital reconstruction. Within the experimental part, 10 residents and 5 experienced maxillofacial surgeons were added. All data and customised software were well documented and then used in a single clinical case of orbital floor reconstruction. Results: Visual assessment of plate positioning within the experiment revealed proper plate positioning in 8 cases. A comparison of virtual and real measurements showed a stable deviation of 0.65-1.15 (mean 0.9 mm). As a result of the clinical implementation of MR technology, after surgical reconstruction, the patient showed improvement in ocular mobility and reduction of diplopia. A postoperative computed tomography scan showed proper plate positioning. Discussion: Implementation of MR based on VP could significantly improve the results of preoperative planning, intraoperative navigation, and surgery. However, existing technical limitations that relate to navigation principles could produce mistakes and errors. Therefore, further investigations related to the 6 degrees of freedom problem solution are considered reasonable in the elimination of listed issues.
ABSTRACT
INTRODUCTION: Orbital floor fractures are common among mid-face fractures. The general aim of treatment is to restore orbital volume and anatomy with grafts or reconstructive materials. Malpositioning of the implants and inadequate volume restorations are common complications of these procedures. The aim of our study is to present the surgical outcomes of orbital reconstruction aided by our algorithm of patient-specific virtual planning. MATERIALS AND METHODS: The current study was performed on 77 patients with orbital wall fractures who were categorized into two groups: Group A - 42 patients (virtual planning) and Group B - 35 patients (traditional approach). Criteria of analysis included the presence of diplopia postoperatively and duration of surgical procedures. RESULTS: Diplopia was recorded right after surgery in 16 cases (38.1%) of Group A and in 12 cases (34.3%) of Group B. However, 6 months postreconstruction, residual diplopia was recorded in 4 cases (9.5%) of Group A and in 12 cases (34.3%) of Group B. Mean operation time in Group A for the patients with isolated zygoma fracture was 2.23 h; for isolated orbital wall fracture was 1.98 h; and for combined zygoma, orbital wall, and facial bone fracture was 3.07 h. In Group B, these indexes were 3.47, 2.05, and 3.31 h, respectively. CONCLUSIONS: Application of virtual planning could significantly improve postoperative outcomes in orbital reconstruction. However, application of this technology could be limited by complicated defects of the orbital walls, which would require complex shape of the implant that might be difficult to be prevent virtually.
ABSTRACT
Routine reconstruction of subtotal defects of the mandible and orthopedic rehabilitation supported by dental implants is achieved by means of detailed planning and lasts over a year. This article shows the outcomes of single-stage surgical treatment and immediate orthopedic rehabilitation performed with the help of preoperative virtual computer simulation. 3D investigation of pathological and donor sites, virtual simulation of tumor resection, positioning of the dental implants into fibula, virtual flap bending and transfer, virtual bending of fixing reconstruction plates, and fabrication of navigation templates and bridge prosthesis supported by dental implants were done preoperatively. The surgery included tumor resection, insertion of dental implants into fibula, elevation of fibula osteocutaneous free flap, rigid fixation within recipient site, and immediate loading by bridge orthopedic device. On 10-month follow-up, functional and esthetic results were asses as reasonable. Radiography showed dental implants to be integrated and positioned appropriately. We found that successful rehabilitation of the patients with extensive defects of the jaws could be achieved by ablative tumor resection, dental implants insertion prior to flap elevation guided by navigation templates, further osteotomy, modeling of the flap based on navigation template, flap transfer, and rigid fixation within recipient site by prebended plates, with application of prefabricated prosthesis.
