Novelli Giorgio, Tonellini Gabriele, Mazzoleni Fabio, Bozzetti Alberto, Sozzi Davide
Department of Maxillo Facial Surgery, University of Milano - Bicocca, San Gerardo Hospital, Monza, Italy.
Department of Maxillo Facial Surgery, University of Milano - Bicocca, San Gerardo Hospital, Monza, Italy.
J Craniomaxillofac Surg. 2014 Dec;42(8):2025-34. doi: 10.1016/j.jcms.2014.09.009. Epub 2014 Oct 5.
Correction of post traumatic orbital and zygomatic deformity is a challenge for maxillofacial surgeons. Integration of different technologies, such as software planning, surgical navigation and stereolithographic models, opens new horizons in terms of the surgeons' ability to tailor reconstruction to individual patients. The purpose of this study was to analyze surgical results, in order to verify the suitability, effectiveness and reproducibility of this new protocol.
Eleven patients were included in the study. Inclusion criteria were: unilateral orbital pathology; associated diplopia and enophthalmos or exophthalmos, and zygomatic deformities. Syndromic patients were excluded. Pre-surgical planning was performed with iPlan 3.0 CMF software and we used Vector Vision II (BrainLab, Feldkirchen, Germany) for surgical navigation. We used 1:1 skull stereolithographic models for all the patients. Orbital reconstructions were performed with a titanium orbital mesh. The results refer to: correction of the deformities, exophthalmos, enophthalmos and diplopia; correspondence between reconstruction mesh positioning and preoperative planning mirroring; and the difference between the reconstructed orbital volume and the healthy orbital volume.
Correspondence between the post-operative reconstruction mesh position and the presurgical virtual planning has an average margin of error of less than 1.3 mm. In terms of en- and exophthalmos corrections, we have always had an adequate clinical outcome with a significant change in the projection of the eyeball. In all cases treated, there was a complete resolution of diplopia. The calculation of orbital volume highlighted that the volume of the reconstructed orbit, in most cases, was equal to the healthy orbital volume, with a positive or negative variation of less than 1 cm(3).
The proposed protocol incorporates all the latest technologies to plan the virtual reconstruction surgery in detail. The results obtained from our experience are very encouraging and lead us to pursue this path.
创伤后眼眶及颧骨畸形的矫正对外科颌面外科医生来说是一项挑战。整合不同技术，如软件规划、手术导航和立体光刻模型，为外科医生根据个体患者定制重建方案的能力开辟了新视野。本研究的目的是分析手术结果，以验证这一新方案的适用性、有效性和可重复性。
11名患者纳入本研究。纳入标准为：单侧眼眶病变；伴有复视和眼球内陷或眼球突出，以及颧骨畸形。综合征患者被排除。术前规划使用iPlan 3.0 CMF软件，手术导航使用Vector Vision II（德国费尔德基兴的BrainLab公司）。所有患者均使用1:1颅骨立体光刻模型。眼眶重建采用钛制眼眶网。结果涉及：畸形、眼球突出、眼球内陷和复视的矫正；重建网定位与术前规划镜像之间的对应关系；以及重建眼眶体积与健康眼眶体积之间的差异。
术后重建网位置与术前虚拟规划之间的对应平均误差 margin 小于1.3毫米。在眼球内陷和眼球突出矫正方面，我们始终取得了足够的临床效果，眼球突出有显著变化。在所有治疗病例中，复视均完全消失。眼眶体积计算表明，在大多数情况下，重建眼眶的体积与健康眼眶体积相等，正负变化小于1立方厘米。
所提出的方案整合了所有最新技术，以详细规划虚拟重建手术。我们从经验中获得的结果非常令人鼓舞，促使我们继续这条道路。
