Virtual planning of orbital bone reconstruction surgery

Virtual planning of orbital bone reconstruction surgery

Seleznev V. A., Butsan S. B., Jigitaliyev Sh. N., Khokhlachev S. B., Hodyachiy A. E., Chernenkiy M.M

Purpose. To improve the effectiveness of surgical treatment of patients with middle face post-traumatic defects and deformations by developing of computer modeling methods.
Central Research Institute of Dental and Maxillofacial Surgery



Materials and methods. From 2016 to 2017, 61 patients with posttraumatic middle face deformations underwent surgical treatment in the department of maxillofacial surgery of Central Research Institute of Dental and Maxillofacial Surgery. Patients were divided by se-verity and duration of injury. All patients underwent computer planning for reconstructive operation, production of intraoperative stereolithographic models and templates, and the production of individual silicone implants using 3D modeling. At each stage of surgical treat-ment, control calculations of computer tomography data were performed. In 34 patients, bone autografts of the cranial vault were used as a plastic material, in 4 patients the cortical plate of the mandibular branch was used. Seven patients were fitted with reticular titanium im-plants with a polymer coating. In 8 patients, the reconstruction was performed using individ-ually modeled silicone implants. Five patients underwent two-stage surgical treatment, in-cluding reconstruction of the orbital walls with the help of bone autografts from the cranial vault, and in the subsequent - the second stage - elimination of the residual enophthalmus with an individual silicone implant. In three cases, bilateral eye socket damage was observed. In the remote postoperative period (8 months), a control study was performed based on MSCT data. Results. When bone autografts were used from the cranial vault, residual enophthalmos developed in 9 patients (26.5%). When bone autograft was used in the mandibular branch, residual enophthalmos appeared in one patient (25%). When a reticular titanium implant was used, residual enophthalmos was determined in two patients (28.5%), 9 out of 10 patients with residual enophthalmic were re-operated using individually modeled silicone implants. In the long-term observation of violations of the position of the eyeball is not revealed. Conclusions. The development of residual enophthalmos is determined by the appearance of a disproportional ratio of the volume of the orbit and its contents. The main reason for this violation is the impossibility of accurately recreating the complex orbital architecture with only flat plastic materials. The most rational solution to this problem is the use of two-stage surgical tactics, which allows reconstructing their relief on the basis of the restored borders of the orbit with high accuracy using an individual silicone implant.

Keywords: eye socket trauma, eye socket reconstruction, multi-helical computed to-mography (MSCT), segmentation, computer modeling, CAD systems, stereolithography, 3D modeling, residual enophthalmos.

 

Corresponding author:Seleznev V. A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Seleznev V. A., Butsan S. B., Jigitaliyev Sh. N., Khokhlachev S. B. Hodyachiy A. E. Virtual planning of orbital bone reconstruction surgery. REJR 2018; 8 (3):128-148. DOI:10.21569/2222-7415-2018-8-3-128-148.

Received: 22.06.18Accepted:06.07.18