Abstract
Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.
Highlights
The goal of orbital reconstruction after traumatic injury is to restore the anatomy and function of the orbit.[1,2,3,4] Preformed titanium orbital implants have the potential to accurately reconstruct the anatomy,[4,5,6] and virtual planning software allows the surgeon to evaluate the fit of an implant and try out implants of different shapes, sizes, and manufacturers.[4,7] The optimal position of an implant, in which the reconstruction mimics the pre-traumatic shape of the orbit as closely as possible, can be determined by virtual planning.R
The main goal of this study was to demonstrate the feasibility of obtaining visual feedback with an insertion instrument, and the second goal was to evaluate the effect of this feedback on the positioning accuracy of an orbital implant
The reflective marker lay-out of the Softouch navigation pointer (Brainlab AG) was a leader in the design of the instrument, since its first application was as a navigation insertion instrument for real-time navigation in orbital reconstruction
Summary
The goal of orbital reconstruction after traumatic injury is to restore the anatomy and function of the orbit.[1,2,3,4] Preformed titanium orbital implants have the potential to accurately reconstruct the anatomy,[4,5,6] and virtual planning software allows the surgeon to evaluate the fit of an implant and try out implants of different shapes, sizes, and manufacturers.[4,7] The optimal position of an implant, in which the reconstruction mimics the pre-traumatic shape of the orbit as closely as possible, can be determined by virtual planning.R. Schreurs et al / British Journal of Oral and Maxillofacial Surgery 59 (2021) 826–830 limited overview due to protruding orbital tissues hamper visual appraisal of its position.[9,12,13,14,15] Intraoperative navigation, which enables evaluation of the acquired position of an implant during surgery by comparing it to the planned position in the surgical plan, has been shown to increase the predictability of positioning.[13,16,17]
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