Orbital Volume Measurements Research Articles

Classical Orbital Floor Post-Traumatic Reconstruction vs. Customized Reconstruction with the Support of "In-House" 3D-Printed Models: A Retrospective Study with an Analysis of Volumetric Measurement.

Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers ("In-House" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the "Magna Graecia" University Hospital of Catanzaro 10 fulfilled the study's inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient's anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

Automated 3-D Computer-Aided Measurement of the Bony Orbit: Evaluation of Correlations among Volume, Depth, and Surface Area.

(1)The study aimed to measure the depth, volume, and surface area of the intact human orbit by applying an automated method of CT segmentation and to evaluate correlations among depth, volume, and surface area. Additionally, the relative increases in volume and surface area in proportion to the diagonal of the orbit were assessed. (2) CT data from 174 patients were analyzed. A ball-shaped mesh consisting of tetrahedral elements was inserted inside orbits until it encountered the bony boundaries. Orbital volume, area depth, and their correlations were measured. For the validation, an ICC was used. (3) The differences between genders were significant (p < 10-7) but there were no differences between sides. When comparing orbit from larger to smaller, a paired sample t-test indicated a significant difference in groups (p < 10-10). A simple linear model (Volume~1 + Gender + Depth + Gender:Depth) revealed that only depth had a significant effect on volume (p < 10-19). The ICCs were 1.0. (4) Orbital volume, depth, and surface area measurements based on an automated CT segmentation algorithm demonstrated high repeatability and reliability. Male orbits were always larger on average by 14%. There were no differences between the sides. The volume and surface area ratio did not differ between genders and was approximately 0.75.

Patient-Specific Implant Customization for Treatment of Internal Orbital Fractures Using Office-Based Three-Dimensional Printing.

Three-dimensional (3D) modeling technology aids the reconstructive surgeon in designing and tailoring individualized implants for the reconstruction of complex craniofacial fractures. Three-dimensional modeling and printing have traditionally been outsourced to commercial vendors but can now be incorporated into both private and academic craniomaxillofacial practices. The goal of this report is to present a low-cost, standardized office-based workflow for restoring bony orbital volume in traumatic orbital fractures. Patients with internal orbital fractures requiring open repair were identified. After the virtual 3D models were created by iPlan 3.0 Cranial CMF software (Brainlab), the models were printed using an office-based 3D printer to shape and modify orbital plates to correctly fit the fracture defect. The accuracy of the anatomic reduction and the restored bony orbital volume measurements were determined using postoperative computed tomography images and iPlan software. Nine patients fulfilled the inclusion criteria: 8 patients had unilateral fractures and 1 patient had bilateral fractures. Average image processing and print time were 1.5 hours and 3 hours, respectively. The cost of the 3D printer was $2500 and the average material cost to print a single orbital model was $2. When compared with the uninjured side, the mean preoperative orbital volume increase and percent difference were 2.7 ± 1.3mL and 10.9 ± 5.3%, respectively. Postoperative absolute volume and percent volume difference between the orbits were -0.2 ± 0.4mL and -0.8 ± 1.7%, respectively. Office-based 3D printing can be routinely used in the repair of internal orbital fractures in an efficient and cost-effective manner to design the implant with satisfactory patient outcomes.

Longitudinal Comparison of Orbital Volumes from Enucleated Eyes with Hydroxyapatite Orbital Implant in Unilateral Retinoblastoma Patients.

To compare the orbital volume between enucleated and contralateral, uninvolved orbits over a 5-year period in patients with unilateral retinoblastoma who underwent enucleation with hydroxyapatite (HA) implant placement by a single surgeon. A retrospective review was performed on the clinical records and radiographic images of unilateral retinoblastoma patients who underwent enucleation with primary HA implantation from 2003 to 2020 at a single institution. Bilateral orbital volume measurements were taken from the initial postoperative MRI scan and again at 1- and 5-years postenucleation. The main outcome measure was the longitudinal change in volume difference (∆𝑉). The implant size, age at enucleation, and sex were also evaluated. A linear mixed-effect model was used for analysis. A total of 124 patients (73 males) with HA implants following enucleation were included. Overall, the unaffected orbit trended toward having a greater volume compared with the enucleated orbit, but this was not statistically significant (β = 0.003; p = 0.122). The mean age at enucleation was 2.4 years. The median time between enucleation and the initial, 1-year, and 5-year postoperative MRIs was 6 months, 17 months, and 55 months, respectively. There was no statistical correlation between age at enucleation, gender, implant size, or orbital volume at any time points ( p > 0.05). Patients treated with enucleation and primary HA implant placement for unilateral retinoblastoma did not display significant asymmetry in orbital volume on 5-year postenucleation MRIs, suggesting that HA implants promote orbital growth comparable to a nonenucleated orbit in the pediatric population.

A clinical study of the effect of 3D reconstruction on exophthalmos after an operation on an old orbital wall fracture.

Orbital blowout fracture is common in ocular trauma. Accurate measurement of orbital volume after fracture is key in improving intraocular correction. This study aims to explore the impact of 3D reconstruction technology in restoring normal exophthalmos in patients with old orbital wall fractures. A total of 31 patients were randomly divided into an experimental group (n= 15) and a control group (n= 16). For orbital wall repair and reconstruction, the conventional group used the conventional surgical scheme, and the 3D group used 3D printing technology. There was no statistical difference between the preoperative mean extraocular muscle volume of the healthy eye and the affected eye. However, the mean orbital volume (24.76 vs 27.11, P= 0.005) and mean retrobulbar fat volume (17.53 vs 16.42, P= 0.006) were significantly different between the healthy eye and the affected eye. After an average follow-up of 16 weeks, the differences in pre- and post-surgery exophthalmos in the two groups were 0.42 ± 0.08 mm and 1.63 ± 0.51 mm, respectively. The difference between the two groups was statistically significant (t= 4.42, P= 0.003). The complications were not statistically different. Using 3D reconstruction technology preoperatively can significantly improve exophthalmos in patients with old orbital wall fractures.

Comparison of Orbital Reconstructive Effect between Customized Orbital Implants Using Three-Dimensional Printed Templates and Conventional Manual-Bending Implants in Blowout Fracture Surgery

The aim of the present study was to determine the orbital reconstructive effect of customized orbital implants using three-dimensional (3D) printed templates compared with conventional manual-bending implants using computed tomography (CT)-based orbital volume measurements. This retrospective study reviewed the medical records and 3D-CT images of 90 patients who underwent medial, inferior, or inferomedial orbital wall reconstruction. The selected patients were categorized into two groups: (1) the 3D group that underwent surgery using 3D-printed customized orbital implant templates and (2) the manual group that received a conventional manual technique to mold the implant. The volume discrepancy (VD) was obtained by subtracting the volume of the contralateral unaffected eye from that of the injured eye. Of the 90 patients, 33 and 57 were divided into the 3D and manual groups, respectively. The volumes on the contralateral unaffected side and on the pre- and postoperative injured sides were 22.5 ± 2.9, 23.7 ± 3.0, and 22.3 ± 2.8 cm3 (mean ± SD), respectively, in the 3D group, and 21.5 ± 2.5, 22.7 ± 2.8, and 21.2 ± 2.7 cm3 in the manual group. The postoperative VD did not differ between the 3D (–0.2 ± 0.3 cm3) and manual (–0.3 ± 0.9 cm3) groups (p = 0.794). The volume on the postoperative injured side did not differ significantly from that on the contralateral unaffected side in the 3D group, but these did differ significantly in the manual group. Postoperative VD also increased with the preoperative VD in the manual group (Pearson correlation coefficient = 0.548, p = 0.001), whereas there was no such association in the 3D group. The orbital volume restoration effect had superior surgical outcomes for large fractures using the customized orbital implant with 3D-printed templates compared with manual-bending implants.

Technical considerations of computer-aided planning in severe orbital trauma: A retrospective study

The aim of this study was to evaluate the clinical outcomes of linear and orbital volume measurements in severe orbital trauma. Patients with severe orbital trauma that involved more than two walls and entailed a marked degree of comminution were included in this retrospective analysis. However, patients with incomplete clinical records and a simple blowout or zygmatico-orbital fractures were excluded. All the cases underwent surgical correction guided by virtual surgical planning and 3D-printed templates. The measurement protocol depended on assessing orbital dimensions, orbital volumetry, and the zygomatic bone's position in the three-dimensional planes. All patients' preoperative 3D CT scans were obtained, and DICOM files were imported into a three-dimensional image processing software. Data were then converted for 3D reconstruction in the axial, coronal, and sagittal views. A total of 18 patients with a mean age was 39.28 ± 6.28 were included in this study. The results revealed a significant difference between the pre and postoperative differences in distances in relation to the FHP (Frankfurt Horizontal Plane) (P = 0.0014) and sagittal planes (P < 0.0001). The orbital width and height of the traumatized orbit were significantly decreased from 45.26 ± 6.72 mm and 45.30 ± 2.89 mm to 39.74 ± 3.91 mm (P = 0.0022), and 40.34 ± 0.86 mm (P < 0.0001), respectively. Clinically, there was a satisfactory degree of symmetry regarding the zygomatic bones' position and orbital dimensions postoperatively. Moreover, the mean orbital volume on the traumatized side decreased significantly from 23.16 ± 1.91 cm3 preoperatively to 20.7 ± 1.96 cm3 postoperatively (P < 0.0001). These findings were associated with a low incidence of complications. Within the limitations of the study it seems that the described methodology is a relevant addition to clinical treatment options. It incorporates all the latest technology to plan virtual reconstruction surgery in the treatment of complex orbital trauma and should be adapted accordingly in cases of severe displacement and comminution.

Comparison of orbital volume measured using computed tomography and fluid displacement: A comparative study using dry skull

Objectives: The purpose of the study was as follows: (1) To compare orbital volume calculated using computed tomography (CT) scans with real-time measurements. (2) To evaluate if the orbital volume of the adjacent orbit can be taken as a tool of comparison for orbital volume correction in orbital fractures. Materials and Methods: A prospective study was conducted on 30 orbital cavities with intact orbital walls. The foramina and fissures were sealed using molding wax. Alginate impressions of the orbital cavity were taken to determine the orbital volume using the Archimedes principle. GE light speed 64 slices CT scanner was used to scan the orbits with 0.8 mm sections. Orbital volume was calculated using the CT software GE ADW 4.5 workstation. Results: The comparison of CT measurement and Archimedes principle measurement shows a mean and standard error of 0.2333 mm and 0.09794, respectively, on the right orbits and a mean and standard error of 0.10011 mm and 0.0981, respectively, on the left orbits. The comparison of the right and left orbits shows a mean and standard error of 0.4067 mm and 0.2771 mm, respectively, using the Archimedes principle and a mean and standard error of 0.3300 mm and 0.2775, respectively, using CT scans. Conclusion: It was found that the difference in orbital volume between CT and real-time measurement is very negligible. The study shows that CT is a reliable tool for the orbital volume measurement and the adjacent orbit can be taken as a comparative tool for the orbital volume corrections.

3D printing for orbital volume anatomical measurement.

The aim was to develop a method for reproducible orbital volume (OV) measurement in vivo based on 3D printing. Twelve orbits were obtained from dry skulls of the Human Anatomy Department of Lille University. Computer tomography (CT) slice images of these orbits were transformed into stereo-lithography (STL) format and 3D-printed. Bone openings were closed using either putty and cellophane after printing (3D-Orb-1) or at the printing stage in silico using MeshMixer (3D-Orb-2). The results were compared with those of the conventional water-filling method as a control group (Anat-Orb). The observers reported a mean orbital volume of 21.3 ± 2.1 cm3 for the open-skull method, 21.2 ± 2.4 cm3 for the non-sealed 3D-printing method, and 22.2 ± 2.0 cm3 for the closed-print method. Furthermore, the intraclass correlation coefficients (ICCs) showed excellent intra-rater agreement, i.e., an ICC of 0.994 for the first observer and 0.998 for the second, and excellent interobserver agreement (ICC: 0.969). The control and 3D-Orb-1 groups show excellent agreement (ICC: 0.972). The 3D-Orb-2 exhibits moderate agreement (ICC: 0.855) with the control and appears to overestimate orbital volume slightly. Our 3D-printing method provides a standardized and reproducible method for the measurement of orbital volume.

Orbital Volume and Axial Length Development in Individuals Ages 12 to 60 Years With Congenital Microphthalmia: A Retrospective Cohort Study.

To analyze the stimulating effect of axial length development on orbital volume development in patients (ages 12-60 years) with congenital microphthalmia. This retrospective cohort study included 43 patients (86 eyes) with congenital microphthalmia. Three-dimensional images of the orbit were generated from past computed tomography scans, and digital orbital volume and axial length measurements were taken. The patients were divided into four age groups for analyses. Paired t tests and one-way analysis of variance tests were used to compare orbital volume and axial length between the affected and unaffected eyes. Pearson correlation analyses and scatter plots were used to investigate the correlations between age, orbital volume, and axial length in the affected and unaffected eyes. Linear regression analysis was used to determine the association between orbital volume and axial length. The mean orbital volume in the affected and unaffected eyes was 17.08 ± 2.88 and 20.80 ± 2.55 cm3, respectively. The mean axis length in the affected and the unaffected groups was 12.73 ± 3.54 and 23.84 ± 1.43 mm, respectively. Significant differences were observed among orbital (t = 13.538, P < 0.001) volume and axial length (t = 21.339, P < 0.001) in the affected and the unaffected groups. There were no significant differences in affected orbital volume (F = 0.527, P > 0.05), unaffected orbital volume (F = 1.628, P > 0.05), affected axial length (F = 0.946, P > 0.05), and unaffected axial length (F = 2.217, P > 0.05) among the four age groups. According to the Pearson correlations, there were no significant correlations between age and affected volume, unaffected volume, affected axis, and unaffected axis (r = 0.095, 0.097, 0.084, and 0.022, respectively; all P > 0.05). Orbital volume was moderately correlated with axial length in the affected and unaffected groups (r = 0.470 and 0.410, respectively; both P < 0.01). Linear regression analysis revealed that a 1 mm change in axis length was associated with a 0.38 cm3 and 0.73 cm3 change in orbital volume in the affected and unaffected groups, respectively. In individuals ages 12 to 60 years old with congenital microphthalmia, the effect of axis length on the orbital volume growth of the affected eye is only half that of the unaffected eye. The eyeball, orbital tissue, and craniofacial development all play an important role in the growth of orbital volume.

Accuracy of globe-sparing orbital reconstruction using individually bent titanium mesh: A comparative study

Accurate reconstruction of orbital and midfacial defects following extensive globe-sparing maxillectomy is challenging, due to the complex anatomy of facial skeleton. The aim of this study is to evaluate the outcomes of individually bent titanium mesh in navigation-assisted reconstruction of post-ablative orbits in comparison with that without intraoperative navigation. Forty-one patients undergone globe-sparing maxillectomy and orbital floor reconstruction using individually bent titanium mesh with or without intraoperative navigation were assessed. Pre- and postoperative orbital projection and volume measurements were performed on both orbits. The unaffected orbit was used as a control for comparison. True-to-original orbital reconstruction was achieved in this study. The average difference of globe projection and orbital volume between unaffected and reconstructed orbits was 0.8±0.5mm and 0.9±1.2cm3, respectively, in navigation-assisted group. In non-navigation-assisted group, the average difference of globe projection and orbital volume of unaffected and reconstructed orbit was 0.7±0.5mm and 1.3±1.3cm3, respectively. There was no statistical significance in mean differences between unaffected and affected globe projection (P=0.744) and orbital volume (P=0.677) in both groups. There was also no significant difference observed when comparing the mean differences between pre- and postoperative globe projection (P=0.659) and orbital volume (P=0.582) in both groups. While intraoperative navigation system was shown to be effective in orbital reconstruction in the past decade, equal satisfactory post-ablative orbital reconstruction can be achieved with individually bent titanium mesh with or without intraoperative navigation.

Accurate reconstruction of bone defects in orbital–maxillary–zygomatic (OMZ) complex with polyetheretherketone (PEEK)

The aim of this study was to evaluate the safety and efficacy of using patient-specific polyetheretherketone (PEEK) for the reconstruction of patients with defects in orbital-maxillary-zygomatic (OMZ) complex. This study included 12 patients who underwent primary/delayed reconstruction of defects in OMZ complex by using patient-specific PEEK implants. Postoperative appearance (facial and orbital symmetry) and function were assessed after 6 months. Ophthalmologic examinations including globe position, exophthalmos, and orbital volume measurement were also performed. A comparative analysis of the treatment outcomes between pre- and postoperation was performed, and a value of P < 0.05 was considered as significant. All patients underwent planned surgical procedure successfully. No obvious complications occurred. Facial symmetry and globe position were improved after surgery and the postoperative esthetic assessment was rated as excellent. The postoperative evaluation revealed that exophthalmos was 15.91±1.80mm, vertical position difference of eyeball 15.91±1.80mm, and orbital volume 15.91±1.80mm, respectively. There was a statistically significant difference in the mean values of exophthalmos, vertical position difference, and orbital volume among pre- and postoperation conditions, whereas there was no statistically significant difference between the reconstructed side and the unaffected side after surgery. With the aid of virtual surgical planning and individual custom-made surgical guides, patient-specific PEEK implantation can successfully reconstruct the complicated 3D structure of OMZ complex and shows excellent biocompatibility and clinical outcomes.

Reliability of 3 Strategies of Orbital Tumor Volume Measurement Using Phantom Modeling.

The reliability of 3 volume measurement strategies was investigated using MRI and a simple method for creating phantom orbit tumors. Water-based starch was molded into orbital "tumors" of 3 shapes (sphere, ovoid, diffuse); water displacement was used to calculate volume. "Tumors" were placed into 3D-printed orbit phantoms, MRIs were obtained and volume analysis was performed. Observers measured tumor volume using ellipsoid volume (EV), manual segmentation, and semi-automated segmentation strategies. Intraclass correlation coefficients were calculated comparing observer measurements to true volumes. The coefficient of repeatability determined the percentage of tumor volume change required for each method to detect tumor growth. Intraclass correlation coefficients comparing measured volumes to true volumes using EV, manual segmentation, and semi-automated segmentation were 0.61, 0.98, and 0.99 for spherical, 0.64, 0.97, and 0.98 for ovoid, and 0.18, 0.82, and 0.87 for diffuse tumors. Semi-automated segmentation followed by manual segmentation had the highest correlation between measured and true tumor volume for all 3 tumor geometries. EV had low correlation with true volume for all tumor geometries. Diffuse tumors had high variability and low correlation for all 3 measurement techniques. This study shows the reliability of 3 strategies to measure orbital tumor volume with MRI based on tumor geometry, using a simple phantom model. EV, the most commonly employed strategy in clinical practice, had low correlation and high variability across tumor shapes. Using manual segmentation and semi-automated segmentation, a measured change in volume greater than 25% may be considered true growth, while the EV strategy required a 40%-400% change in volume to reliably measure tumor growth.

Reliability of orbital volume measurements based on computed tomography segmentation: Validation of different algorithms in orbital trauma patients

PurposeTo compare the most common methods of segmentation for evaluation of the bony orbit in orbital trauma patients. Materials and methodsComputed tomography scans (before and after treatment) from 15 patients with unilateral blowout fractures and who underwent orbital reconstructions were randomly selected for this study. Orbital volume measurements, volume difference measurements, prolapsed soft tissue volumes, and bony defect areas were made using manual, semi-automated, and automated segmentation methods. ResultsVolume difference values between intact and damaged orbits after surgery using the manual mode were 0.5 ± 0.3 cm3, 0.5 ± 0.4 cm3 applying semi-automated method, and 0.76 ± 0.5 cm3, determined by automated segmentation (р = 0.216); the mean volumes (MVs) for prolapsed tissues were 3.0 ± 1.9 cm3, 3.0 ± 2.3 cm3, and 2.8 ± 3.9 cm3 (p = 0.152); and orbital wall defect areas were 4.7 ± 2.8 cm2, 4.75 ± 3.1 cm2, and 4.9 ± 3.3 cm2 (p = 0.674), respectively. ConclusionsThe analyzed segmentation methods had the same accuracy in evaluation of volume differences between two orbits of the same patient, defect areas, and prolapsed soft tissue volumes but not in absolute values of the orbital volume due to the existing diversity in determination of anterior closing. The automated method is recommended for common clinical cases, as it is less time-consuming with high precision and reproducibility.

Orbital volume measurements from magnetic resonance images using the techniques of manual planimetry and stereology.

Introduction:Current volume measurement techniques, for the orbit, are time-consuming and involve complex assessments, which prevents their routine clinical use. In this study, we evaluate the applicability and efficacy of stereology and planimetry in orbital volume measurements using magnetic resonance imaging (MRI).Materials and Methods:Prospective imaging study using MRI. Sheep craniums and human subjects were evaluated. Water-filling measurements were performed in animal skulls, as the standard validation technique. Planimetry and stereology techniques were used in each dataset. Intraobserver and interobserver reliability testing were applied.Results:In stereology customization, 1/6 systematic sampling scheme was determined as optimal with acceptable coefficient of error (3.09%) and low measurement time (1.2 min). In sheep craniums, the mean volume measured by water displacement, planimetry, and stereology was 17.81 ± 0.59 cm3, 18.53 ± 0.24 cm3, and 19.19 ± 0.17 cm3, respectively. Planimetric and stereological methods were highly correlated (r = 0.94; P ≈ 0.001). The mean difference of the orbital volume using planimetry and stereology was 0.316 ± 0.168 cm3. In human subjects, using stereology, the mean orbital volume was found to be 19.62 ± 0.2 cm3 with a CE of 3.91 ± 0.15%.Conclusions:The optimized stereological method was found superior to manual planimetry in terms of user effort and time spent. Stereology sampling of 1/6 was successfully applied in human subjects and showed strong correlation with manual planimetry. However, optimized stereological method tended to overestimate the orbital volume by about 1 cc, a considerable limitation to be taken in clinical practice.

Correction of post-traumatic enophthalmos with anatomical absorbable implant and iliac bone graft.

BackgroundTrauma is one of the most common causes of enophthalmos, and post-traumatic enophthalmos primarily results from an increased volume of the bony orbit. We achieved good long-term results by simultaneously using an anatomical absorbable implant and iliac bone graft to correct post-traumatic enophthalmos.MethodsFrom January 2012 to December 2016, we performed operations on seven patients with post-traumatic enophthalmos. In all seven cases, reduction surgery for the initial trauma was performed at our hospital. Hertel exophthalmometry, clinical photography, three-dimensional computed tomography (3D-CT), and orbital volume measurements using software to calculate the specific volume captured on 3D-CT (ITK-SNAP, Insight Toolkit-SNAP) were performed preoperatively and postoperatively.ResultsPatients were evaluated based on exophthalmometry, clinical photographs, 3D-CT, and orbital volume measured by the ITK-SNAP program at 5 days and 1 year postoperatively, and all factors improved significantly compared with the preoperative baseline. Complications such as hematoma or extraocular muscle limitation were absent, and the corrected orbital volume was well maintained at the 1-year follow-up visit.ConclusionWe present a method to correct enophthalmos by reconstructing the orbital wall using an anatomical absorbable implant and a simultaneous autologous iliac bone graft. All cases showed satisfactory results for enophthalmos correction. We suggest this method as a good option for the correction of post-traumatic enophthalmos.

Orbital Volume Evaluation post Orbital Fractures Restoration

Background: The orbits are bony structures of the skull that house the globe , extra ocular muscles (EOM), nerves, blood vessels, lacrimal apparatus and adipose tissue. Each orbit protect the globe, while the supportive tissues therein allow the globe to move in three dimensions (horizontal –verticalrotational). Objectives: Evaluation of orbital volume after orbital fractures reconstruction by software orbital volume measurement using CT scan. Patients and methods: This study was conducted on 20 patients with a unilateral orbital blowout fracture treated surgically at Department of Plastic and Reconstructive Surgery in AL-Azhar University Hospitals from October 2018. To October 2019 and followed for 3 months were identified and included in this study. Results: 5% of patients had positive limitation of EOM and 90% of patients were good Pt. acceptance post-operative. 5% of patients were dystopia post-operative, all of patients had no infection, enophthalmouse or extrusion. Conclusion: We must exert great effort to prevent occurrence of these injuries through a joint cooperation with civil society through the dissemination of culture and means of safety on the highways. Rules and basics of craniofacial osteosynthesis must be known to craniofacial surgeon starting from wiring osteosynthesis.

Orbital Volume Evaluation post Orbital Fractures Restoration

Background: The orbits are bony structures of the skull that house the globe , extra ocular muscles (EOM), nerves, blood vessels, lacrimal apparatus and adipose tissue. Each orbit protect the globe, while the supportive tissues therein allow the globe to move in three dimensions (horizontal –verticalrotational). Objectives: Evaluation of orbital volume after orbital fractures reconstruction by software orbital volume measurement using CT scan. Patients and methods: This study was conducted on 20 patients with a unilateral orbital blowout fracture treated surgically at Department of Plastic and Reconstructive Surgery in AL-Azhar University Hospitals from October 2018. To October 2019 and followed for 3 months were identified and included in this study. Results: 5% of patients had positive limitation of EOM and 90% of patients were good Pt. acceptance post-operative. 5% of patients were dystopia post-operative, all of patients had no infection, enophthalmouse or extrusion. Conclusion: We must exert great effort to prevent occurrence of these injuries through a joint cooperation with civil society through the dissemination of culture and means of safety on the highways. Rules and basics of craniofacial osteosynthesis must be known to craniofacial surgeon starting from wiring osteosynthesis.

Risk prediction of posttraummatic enophthalmos development on the basis of orbital volume calculations using multislice computed tomography data

Purpose. To elaborate a method of orbital volume measurement in patients with midface trauma at pre- and postoperative stages on the basis of multislice computed tomography (MSCT); to investigate the capabilities of orbital volume measurement to acquire additional diagnostic information and to estimate the risk of postoperative enophthalmos development.&#x0D; Materials and methods. A total of 71 patients (100%) with midface trauma were examined at the Sechenov University clinic. At pre- and postoperative stages, all patients (n = 71, 100%) were examined using MSCT (Toshiba Aquilion One 640) with 0.5 mm slice thickness in bone and soft tissue regimen. To measure orbital volume, MSCT data were processed using Vitrea workstation: bone borders of the right and left orbit were marked before and after surgical treatment on every axial slice, and orbital volumes were presented in ml.&#x0D; Results. Preoperative MSCT data management revealed increased orbital volume due to orbital trauma in 64 patients (90%), the difference between healthy and traumatized orbit was between 2 ml and 14 ml. In these patients, reconstructive surgical procedure was performed. In 7 patients (10%) with mild midface trauma, the difference between orbital volumes was less than 2 ml, this was considered as a positive prognostic factor, and these patients were not subjects to surgical treatment. After surgery, in 55 patients (77%) the orbital volume restored, the difference between orbital volumes was less than 2 ml. In 9 cases (13%), the difference in orbital volume was more than 2 ml, considered as adverse prognostic factor which means that there still was a risk of postoperative enophthalmos development. In this patient group, additional diagnostic examination was necessary, and patients required planning of residual enophthalmos surgical correction with MSCT control during the post-op period.&#x0D; Conclusion. Postprocessing of the MSCT data gave the possibility to calculate pre-and postoperative orbital volume changes and present it in mathematical units (ml) in 3D mode. As the result the additional information can be acquired in order to identify the risk of postoperative enophthalmos.

The accuracy of post-traumatic orbital volume correction using pre-adapted titanium mesh (randomized controlled clinical prospective study)

Aim: Is to evaluate the accuracy of orbital volume correction using pre-adapted titanium mesh with the aid of stl model of corrected orbit.Patients and methods: Ten patients with unilateral orbital floor fracture were included. The cases were divided into two equal groups. Manual group where titanium mesh was manually adapted intra-operatively. STL group where titanium mesh was adapted pre-operatively using stl model of corrected orbit. Orbital volume measurements based on CT images were used to trace the degree of correction in each group. Paired samples t test was used for statistical analysis.Results: There was statistical significant difference in the correction of orbital volume in each group. However, comparison between the two groups revealed no statistical significant difference in the percentage of correction, where the mean percentage of correction in stl group was (102.8 ± 4.4) versus (98.4± 2.6) in the manual group.Conclusion: Application of pre-adapted titanium mesh by the aid of stl model provide successful tool for correction of orbital volume secondary to orbital floor fracture with less operative time and effort especially in comminuted fractures.