Orbital Reconstruction by Patient-Specific Implant Printed in Porous Titanium: A Retrospective Case Series of 12 Patients

Abstract

The purpose of this study was to evaluate the orbital patient-specific implant (PSI) directly printed in porous titanium for the reconstruction of complex orbital bone defects in a series of 12 patients. The authors designed and implemented a case series. The sample consisted of patients with unilateral complex orbital bone loss. All patients received a porous titanium PSI designed from the healthy contralateral side (mirroring). The criteria analyzed were the functional results: correction of enophthalmos, correction of ocular motility, operative time, complications, and operative revisions. The study was performed from 2015 through2017. The sample was composed of 12 patients (mean age, 47yr; age range, 13 to 70yr). Patients were followed for a mean of 36weeks postoperatively (range, 4 to 100weeks). Twelve of the 12 patients presented preoperative enophthalmia, and 8 of the 12 patients presented preoperative diplopia. The mean operating time was 71minutes (range, 60 to 200minutes). For 8 patients, the follow-up was simple. In contrast, 2 patients required surgical revision with repositioning of the implant because of intraoperative implant malpositioning with esthetic or functional disturbance and malpositioning was confirmed on the postoperative computed tomogram, 1 patient required explantation of his implant 7months after the surgery because of spheno-orbital meningioma recurrence (the implant was well positioned), and 1 patient operated on by a subciliary approach presented a postoperative ectropion. In this series of porous titanium orbital PSIs without positioning guides, 17% had malpositioning (2 patients who required a new intervention for repositioning). The results of this study suggest that porous titanium PSI could be a surgical option for patients with complex orbital bone defects. In this series 17% of the sample needed a second operation. There are several ways to improve these results, such as intraoperative navigation or integrated positioning guides.