Cargando…
Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort?
Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair. With anatomically critical structures at risk during the surgical approach, surgeons’ view on the necessity of medial orbital wall...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9500717/ https://www.ncbi.nlm.nih.gov/pubmed/36143174 http://dx.doi.org/10.3390/jpm12091389 |
_version_ | 1784795289879576576 |
---|---|
author | Wilkat, Max Hufendiek, Karsten Karahisarlioglu, Merve Borrelli, Maria Sproll, Christoph Rana, Majeed |
author_facet | Wilkat, Max Hufendiek, Karsten Karahisarlioglu, Merve Borrelli, Maria Sproll, Christoph Rana, Majeed |
author_sort | Wilkat, Max |
collection | PubMed |
description | Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair. With anatomically critical structures at risk during the surgical approach, surgeons’ view on the necessity of medial orbital wall repair often is restricted and an aesthetically disturbing enophthalmos is more likely to be accepted. Therefore, treatment options range from leaving the medial wall without repair to reconstruction with autogenous tissue or alloplastic materials, which can lead to moderate to severe side effects. However, emerging technologies such as patient-specific implants (PSI) offer a reliable and anatomically correct reconstruction of the bony orbit. This study aimed to evaluate the outcome of full orbital reconstruction using PSIs compared to only orbital floor repair using PDS (bioresorbable polydioxanone) foils leaving the medial orbital wall untouched in traumatic two-wall orbital fractures. Of all patients treated at the University Hospital of Düsseldorf between 2017 and 2019 who suffered from traumatic orbital fracture, only patients with a two-wall orbital fracture involving both the orbital floor and the medial wall (n = 68) were included. Patients were treated either with a PSI (n = 35) or a PDS foil (n = 33). Primary outcome parameters were ophthalmological disturbances analyzed via clinical investigation and intra-orbital angles, volumes and implant position analyzed with radiological 3D-datasets. While a two-wall reconstruction using PSIs led to a significant improvement of the enophthalmos, the rate of postoperative enophthalmos was significantly increased in cases of only orbital floor repair with PDS foils. Radiologically, a significant reconstruction of the three-dimensional bony orbit succeeded with the simple use of PSIs leading to a significant reduction in the traumatically enlarged orbital volume. PSI also led to a significant reduction in the traumatically enlarged medial angle of the orbit. This was not the case for single-floor repair with PDS foil. The results of this study suggest that complex orbital fractures can be reconstructed at an even higher degree of accuracy with selective laser-melted PSIs than PDS foils. In order to achieve a true to original reconstruction of the bony orbit, surgical treatment of the medial orbital wall can be advocated for in the long term depending on the indication. |
format | Online Article Text |
id | pubmed-9500717 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-95007172022-09-24 Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? Wilkat, Max Hufendiek, Karsten Karahisarlioglu, Merve Borrelli, Maria Sproll, Christoph Rana, Majeed J Pers Med Article Proper treatment of the two-wall fractured orbit is still controversial. Specifically, there is no consensus on the issue of the necessity of medial orbital wall repair. With anatomically critical structures at risk during the surgical approach, surgeons’ view on the necessity of medial orbital wall repair often is restricted and an aesthetically disturbing enophthalmos is more likely to be accepted. Therefore, treatment options range from leaving the medial wall without repair to reconstruction with autogenous tissue or alloplastic materials, which can lead to moderate to severe side effects. However, emerging technologies such as patient-specific implants (PSI) offer a reliable and anatomically correct reconstruction of the bony orbit. This study aimed to evaluate the outcome of full orbital reconstruction using PSIs compared to only orbital floor repair using PDS (bioresorbable polydioxanone) foils leaving the medial orbital wall untouched in traumatic two-wall orbital fractures. Of all patients treated at the University Hospital of Düsseldorf between 2017 and 2019 who suffered from traumatic orbital fracture, only patients with a two-wall orbital fracture involving both the orbital floor and the medial wall (n = 68) were included. Patients were treated either with a PSI (n = 35) or a PDS foil (n = 33). Primary outcome parameters were ophthalmological disturbances analyzed via clinical investigation and intra-orbital angles, volumes and implant position analyzed with radiological 3D-datasets. While a two-wall reconstruction using PSIs led to a significant improvement of the enophthalmos, the rate of postoperative enophthalmos was significantly increased in cases of only orbital floor repair with PDS foils. Radiologically, a significant reconstruction of the three-dimensional bony orbit succeeded with the simple use of PSIs leading to a significant reduction in the traumatically enlarged orbital volume. PSI also led to a significant reduction in the traumatically enlarged medial angle of the orbit. This was not the case for single-floor repair with PDS foil. The results of this study suggest that complex orbital fractures can be reconstructed at an even higher degree of accuracy with selective laser-melted PSIs than PDS foils. In order to achieve a true to original reconstruction of the bony orbit, surgical treatment of the medial orbital wall can be advocated for in the long term depending on the indication. MDPI 2022-08-27 /pmc/articles/PMC9500717/ /pubmed/36143174 http://dx.doi.org/10.3390/jpm12091389 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Wilkat, Max Hufendiek, Karsten Karahisarlioglu, Merve Borrelli, Maria Sproll, Christoph Rana, Majeed Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? |
title | Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? |
title_full | Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? |
title_fullStr | Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? |
title_full_unstemmed | Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? |
title_short | Prospective Evaluation of Two Wall Orbital Fractures Involving the Medial Orbital Wall: PSI Reconstruction versus PDS Repair—Worth the Effort? |
title_sort | prospective evaluation of two wall orbital fractures involving the medial orbital wall: psi reconstruction versus pds repair—worth the effort? |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9500717/ https://www.ncbi.nlm.nih.gov/pubmed/36143174 http://dx.doi.org/10.3390/jpm12091389 |
work_keys_str_mv | AT wilkatmax prospectiveevaluationoftwowallorbitalfracturesinvolvingthemedialorbitalwallpsireconstructionversuspdsrepairworththeeffort AT hufendiekkarsten prospectiveevaluationoftwowallorbitalfracturesinvolvingthemedialorbitalwallpsireconstructionversuspdsrepairworththeeffort AT karahisarlioglumerve prospectiveevaluationoftwowallorbitalfracturesinvolvingthemedialorbitalwallpsireconstructionversuspdsrepairworththeeffort AT borrellimaria prospectiveevaluationoftwowallorbitalfracturesinvolvingthemedialorbitalwallpsireconstructionversuspdsrepairworththeeffort AT sprollchristoph prospectiveevaluationoftwowallorbitalfracturesinvolvingthemedialorbitalwallpsireconstructionversuspdsrepairworththeeffort AT ranamajeed prospectiveevaluationoftwowallorbitalfracturesinvolvingthemedialorbitalwallpsireconstructionversuspdsrepairworththeeffort |