Kanno Takahiro, Sukegawa Shintaro, Karino Masaaki, Furuki Yoshihiko
1Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, 89-1 Enyacho, Izumo, Shimane Japan.
2Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa Japan.
J Maxillofac Oral Surg. 2019 Sep;18(3):329-338. doi: 10.1007/s12663-019-01207-y. Epub 2019 Mar 21.
Orbital fractures with orbital wall defects are common facial fractures encountered by oral-maxillofacial surgeons, because of the exposed position and thin bony walls of the midface. The primary goal of surgery is to restore the pre-injury anatomy and volume of hard tissue, and to free incarcerated or prolapsed orbital tissue from the fracture by bridging the bony defects with reconstructive implant material and restoring the maxillofacial-orbital skeleton. Numerous studies have reported orbital fracture repair with a wide variety of implant materials that offer various advantages and disadvantages. The ideal orbital implant material will allow conformation to individual patients' anatomical characteristics, remain stable over time, and are radiopaque, especially for the reconstruction of relatively large and/or complex bony walls. Based on these requirements, novel uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets could be used as innovative, bioactive, and osteoconductive/bioresorbable implant materials for orbital reconstruction. In addition, intraoperative navigation is a powerful tool. Navigation- and computer-assisted surgeries have improved execution and predictability, allowing for greater precision, accuracy, and minimal invasiveness during orbital trauma reconstructive surgery of relatively complex and large orbital wall defects with ophthalmological malfunctions and deformities. This review presents an overview of navigation-assisted orbital trauma reconstruction using a bioactive, osteoconductive/bioresorbable u-HA/PLLA system.
伴有眶壁缺损的眼眶骨折是口腔颌面外科医生常见的面部骨折,这是由于面中部位置暴露且骨壁较薄。手术的主要目标是恢复损伤前的硬组织解剖结构和体积,通过用重建植入材料桥接骨缺损并恢复颌面 - 眼眶骨骼结构,使嵌顿或脱垂的眼眶组织从骨折处游离出来。众多研究报道了使用多种植入材料进行眼眶骨折修复,这些材料各有优缺点。理想的眼眶植入材料应能贴合个体患者的解剖特征,随时间保持稳定,并且具有不透射线的特性,特别是用于相对较大和/或复杂骨壁的重建。基于这些要求,新型未煅烧和未烧结的羟基磷灰石(u - HA)颗粒和聚 - L - 丙交酯(PLLA;u - HA/PLLA)复合片可作为用于眼眶重建的创新、生物活性和骨传导/生物可吸收植入材料。此外,术中导航是一种强大的工具。导航和计算机辅助手术改善了手术的执行和可预测性,在伴有眼科功能障碍和畸形的相对复杂和大的眶壁缺损的眼眶创伤重建手术中,可实现更高的精度、准确性和最小的侵入性。本综述概述了使用生物活性、骨传导/生物可吸收的u - HA/PLLA系统进行导航辅助眼眶创伤重建的情况。