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 cm(3), with a regression formula of enophthalmos = 0.446 x orbital volume increment + 2.406. Orbital reconstruction effected a orbital volume decrease of 4.24 +/- 2.41 cm(3) and enophthalmos correction of 2.01 +/- 1.46 mm, the regression formula being enophthalmos = 0.586 x 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 cm(3), and the regression formula was enophthalmos = 0.494 x 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.
Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.