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      Comparison of the outcomes of unilateral orbital fracture repair with and without surgical navigation system: our experience in La Paz University Hospital Translated title: Comparación de los resultados en cirugía de fractura de órbita unilateral con y sin sistema de navegación quirúrgica: experiencia en el Hospital Universitario La Paz

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          Abstract

          ABSTRACT Introduction: Restoration of normal orbital volume and globe position following traumatic injury is often difficult. Intraoperative navigation has emerged as a tool to allow the visualization of the implant position intraoperatively, by means of the planification in the preoperative computed-tomographic scan (CT scan). Objectives: The aim of this study was to compare the postoperative changes in orbital volume between two groups of study: one group that underwent surgical intervention before the implementation of intraoperative navigation (control group), and other group of patients which had undergone surgery with the aid of a navigation system (Software iPlan CMF version 3.0.5, Brainlab(r), Feldkirchen, Germany) (navigation group). Another endpoint of our study was to determine it the presurgical planification and intraoperative navigation aided to position the implant. For that purpose, we determined the implant position with respect to the orbital floor and medial orbital wall and compared it between both groups of study. As secondary endpoints, we compared the rate of postoperative outcomes and reintervention rate between both groups. Materials and methods: A retrospective cohort study was designed. We selected a total of 35 consecutive orbital operations for unilateral orbital fractures performed between 2015 and 2018 at the Department of Oral and Maxillofacial Surgery in La Paz Hospital (Madrid), Spain. We collected information regarding: demographic data, cause of the fracture, time elapsed between diagnosis and surgical treatment, symptoms at diagnosis (diplopia, globe projection, ocular motility impairment), radiological findings (affected wall, muscular entrapment, herniation of the periorbital structures), and outcomes after surgical treatment (diplopia, globe position, ocular motility impairment, reintervention). By means of the iPlan CMF software, the orbital volume was determined in the preoperativeand postoperative CT scan. The plate position was determined by measuring the distance between the plate and the orbital rim, the distance between the plate and the residual posterior intact bony ledge and the distance between the plate and the medial orbital wall. Measurements were performed automatically in the three planes of space, although we used the sagital plane to measure the distance between the plate and the orbital rim and between the plate and the residual posterior intact bony ledge. To measure the distance between the plate and the medial orbital wall we used the axial plane. Results: After surgery, we observed that abnormal globe position was significatively less frequent in the navigation group than in the control group (p = 0.029). The reoperation rate was 11 % in the navigation group and 35% in the control group (p = 0.071). Mean orbital volume of the unaffected orbit was 29.32 ± 2.64 cm3 in the navigation group and 28.64 ± 2.68 cm3 in the control group. Mean orbital volume of the affected orbit was 34.19 ± 3.67 cm3 in the navigation group and 32.78 ± 3.09 cm3 in the control group. Mean reconstructed orbital volume was 29.47 ± 2.75 cm3 in the navigation group and 28.88 ± 3.72 cm3 in the control group. Mean volume reduction and the mean difference in volume between unaffected and reconstructed side did not show significative differences between both groups. The mean distance from plate to orbital floor at the residual posterior intact bony ledge showed significative differences (p = 0.001), being inferior in the navigation group. Conclusions: The use of intraoperative navigation in orbital fractures is effective in improving plate positioning in the residual posterior intact bony ledge of the floor of the orbit, reducing complications such as enophthalmos compared to conventional surgery. Furthermore, the use of intraoperative navigation seems to decrease the rate of reintervention compared to conventional surgery. The restoration of orbital volume seems to be well addressed by both methods.

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          Analysis of Complications After Surgical Repair of Orbital Fractures

          The term "orbital blow-out fracture" is referred to as the mechanism by which an impact to the eyeball is transposed as a mechanical energy to the orbital walls, causing them to fracture. Despite a proper surgical technique, a successful anatomic reconstruction of the orbit, and an accurate follow-up, 3 complications are still frequently observed at long-term follow-up: diplopia, enophthalmos, and hypesthesia of the infraorbital nerve territory. In this retrospective study, we analyze the incidence, the specific characterization, and the potential risk factors of these 3 complications.
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            A prospective multicenter study to compare the precision of posttraumatic internal orbital reconstruction with standard preformed and individualized orbital implants

            A variety of implants are available for orbital reconstruction. Titanium orbital mesh plates are available either as standard preformed implants or able to be individualized for the patient. The aim of this study was to analyze whether individualized orbital implants allow a more precise reconstruction of the orbit than standard preformed implants.
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              Orbital volume measurements in enophthalmos using three-dimensional CT imaging.

              The purpose of this study was to investigate enophthalmos by measuring the volume of various orbital structures using off-line computer techniques on images generated by a CT scanner. Eleven patients with enophthalmos had CT scans of the orbits consisting of 30 to 40 adjacent 1.5-mm slices. The data from the scans were analyzed on a Nova 830 stand-alone computer system using software programs that allowed measurement of total bony orbital volume, total soft-tissue volume, globe volume, orbital fat volume, neuromuscular tissue volume, and apex-to-globe distance in the horizontal plane. These data were analyzed comparing the volumes in the normal eye with the volumes in the enophthalmic eye in each patient. The analysis demonstrated a statistically significant increase in bony orbital volume in the enophthalmic eye, but the total soft-tissue volume, fat volume, neuromuscular tissue volume, and globe volume were the same as in the normal eye. The apex-to-globe distance, a measure of the degree of enophthalmos, was less in the enophthalmic eye than in the normal eye. These results suggest that in the majority of patients, the cause of posttraumatic enophthalmos is increased bony orbital volume rather than by soft-tissue loss or fat necrosis. (Several patients showed no volume discrepancies, and it is likely that cicatricial contracture is responsible for the enophthalmos in these cases.) This study suggests that the objective of surgery for correction of enophthalmos in patients with a volume discrepancy should be to decrease the volume of the bony orbit and to increase the anterior projection of the globe.
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                Author and article information

                Journal
                maxi
                Revista Española de Cirugía Oral y Maxilofacial
                Rev Esp Cirug Oral y Maxilofac
                Sociedad Española de Cirugía Oral y Maxilofacial y de Cabeza y Cuello (Madrid, Madrid, Spain )
                1130-0558
                2173-9161
                December 2020
                : 42
                : 4
                : 149-157
                Affiliations
                [1] Madrid orgnameLa Paz University Hospital orgdiv1Department of Maxillofacial Surgery Spain
                Article
                S1130-05582020000400002 S1130-0558(20)04200400002
                10.20986/recom.2020.1135/2020
                f8883191-15c8-465b-ac65-0ba5cbb0c41d

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 23 September 2020
                : 30 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 9
                Product

                SciELO Spain

                Categories
                Originals

                planification,orbital volume,plate positioning,intraoperative navigation,facial fracture,fracture,posicionamiento de la placa,volumen orbitario,planificación prequirúrgica,navegación intraoperatoria,fractura facial,Fractura de órbita

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