Current Management of Late Posttraumatic Enophthalmos | Journal CME Article-Journal CME Article: Current Management of Late Posttraumatic Enophthalmos Video 5

Video Transcription

In this presentation, I'll demonstrate our preferred technique of patient-specific implant fabrication.  This case here is a patient who presented with impure enophthalmos as a result of an unrepaired fracture involving the left orbital floor and zygoma.  3D computer modeling was first used to design a custom patient-specific implant.  A model is helpful for demonstration purposes and also to help the surgeon in cases where there is deep dissection within the orbit with limited visualization.  Here you can see the lateral orbital wall, the medial orbital wall, and then a big huge cavity.  Way at the back you can see the orbital apex and the small amount of posterior ledge remaining in this patient. There are a number of ways to create a patient-specific implant.  The technique shown here uses a mold and a forming tool.  This will be the shape of the orbital implant that we want, and the second piece acts as a forming tool to allow us to compress the implant.  We generally use a composite implant, which is titanium embedded in porous polyethylene. The mold and the forming tool are loaded into the press.  The implant is then pressed between the mold and the forming tool to obtain the desired shape.  One useful trick is to place the implant in a hot water bath, and by heating the implant you can get it to hold its shape a bit better.  There are two things that are important about the implant. One is the shape of the implant, the other is the orientation. We designed the implant with a bit of a lip on it.  This allows the surgeon to use the lip to help them orient it to the inferior orbital rim.  Here you can see it sitting right up against the rim as it keys in a position that it cannot vary from.  Here you can see the patient-specific implant that was created with 3D computer modeling preoperatively, as well as the post-op CT following enophthalmos repair.  You can see on the post-op CT the dramatic improvement in orbital shape and volume. The post-op worm's eye view on the right shows a significant improvement in globe position.  The post-op AP view on the right also shows a dramatic improvement in globe position as well as improvement in the clinical features of enophthalmos when compared to the preoperative photos.  Thank you.

Video Summary

The presentation details a technique for fabricating patient-specific implants for correcting enophthalmos from an unrepaired orbital fracture. A custom implant design is created via 3D computer modeling for precise surgical application. The implant, made from titanium embedded in porous polyethylene, is shaped using a mold and forming tool, with heat aiding its stability. The importance of implant shape and orientation is emphasized, particularly the use of a lip for proper positioning. Post-operative CT scans and views demonstrate substantial improvements in the orbital structure and eye position, showcasing the technique's effectiveness in restoring orbital anatomy.

Keywords

patient-specific implants

enophthalmos correction

3D computer modeling

titanium polyethylene implant

orbital fracture repair