U Vignesh, Mehrotra Divya, Anand Vaibhav, Howlader Debraj
Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
J Oral Biol Craniofac Res. 2017 Sep-Dec;7(3):212-218. doi: 10.1016/j.jobcr.2017.09.004. Epub 2017 Sep 14.
Purpose of this case report is to highlight the precision and accuracy obtained with patient specific implants for orbital reconstruction designed on the basis of volumetric analysis of orbital computed tomographic scan (CT) scans using virtual planning, computerised designing and manufacturing and stereolithographic models to correct late post-traumatic orbital deformities such as enophthalmos and diplopia.
This case report describes a patient who visited our outpatient clinic for correction of enophthalmos and persistent diplopia in upward gaze, seven months post trauma. Three dimensional (3D) virtual treatment planning was carried out by using the 3D CT data. The unaffected orbit of the contralateral side was superimposed on the deformed orbit to highlight the defect and a customized implant was designed in the desired size and shape on the virtual model using computer aided designing and manufacturing (CAD-CAM) and milled in titanium mesh for precise anatomic orbital reconstruction.
There was a marked improvement in both the diplopia in upward gaze and enophthalmos post surgery when the customized patient specific orbital implant was used.
The concept of using customized implant with the help of 3D virtual treatment planning, 3D stereolithographic models and CAD-CAM greatly improves the correction of extremely difficult late post-traumatic orbital deformities.
本病例报告的目的是强调基于眼眶计算机断层扫描（CT）扫描的容积分析，利用虚拟规划、计算机设计与制造以及立体光刻模型设计的患者特异性植入物，用于眼眶重建，以矫正晚期创伤性眼眶畸形，如眼球内陷和复视，所获得的精度和准确性。
本病例报告描述了一名患者，在创伤后七个月因矫正眼球内陷和向上注视时持续存在的复视而前来我们的门诊。通过使用三维（3D）CT数据进行三维虚拟治疗规划。将对侧未受影响的眼眶叠加在变形的眼眶上以突出缺陷，并使用计算机辅助设计与制造（CAD-CAM）在虚拟模型上设计出所需尺寸和形状的定制植入物，然后在钛网中铣削以进行精确的解剖学眼眶重建。
使用定制的患者特异性眼眶植入物后，向上注视时的复视和眼球内陷在术后均有显著改善。
借助三维虚拟治疗规划、三维立体光刻模型和CAD-CAM使用定制植入物的概念，极大地改善了对极其困难的晚期创伤性眼眶畸形的矫正。
