Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4E, 00029 HUS, Helsinki, Finland.
Oral Maxillofac Surg. 2023 Jun;27(2):333-340. doi: 10.1007/s10006-022-01065-y. Epub 2022 May 18.
We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures (EOFMFs) and evaluate their postoperative functional and aesthetic outcomes in relation to commercially available implants.
We included all patients with primary reconstructions (< 22 days from injury) of EOFMFs treated in our department between January 2011 and October 2020. Extensive orbital floor and medial wall fracture was defined as involvement of orbital floor, medial wall and maxilloethmoidal junction; a fracture defect 5 mm or more; defect size more than a third of both inferior and medial walls; and Jaquiéry classification III or more. Patient characteristics, details of fracture defects and surgeries, postoperative outcomes and implant positions were retrospectively evaluated and compared between study groups.
Nineteen patients were included: 5 with two-piece PSIs and 14 with commercial implants. Implant position was good in 4/5 patients with two-piece PSIs and 2/14 with commercial implants. Revision surgery, globe malposition (GMP) > 2 mm, significant diplopia and poor implant position were more frequent in patients with commercial implants than two-piece PSIs. None of the patients with a good overall implant position had any significant postoperative symptoms.
Extensive orbital fracture reconstructions are somewhat rare, and surgical treatment is associated with a high rate of complications and postoperative symptoms. Titanium-milled two-piece PSIs are well suited for primary reconstructions of EOFMFs, as they lead to more precise reconstructions and fewer postoperative symptoms than commercially available implants.
我们介绍了使用钛铣削的两件式个体化假体（PSI）进行广泛眶底和内侧壁骨折（EOFMF）初次重建的经验，并评估了其与市售假体相关的术后功能和美学效果。
我们纳入了 2011 年 1 月至 2020 年 10 月期间在我科接受初次 EOFMF 重建治疗的所有患者。广泛眶底和内侧壁骨折定义为眶底、内侧壁和上颌筛骨结合部受累；骨折缺损≥5mm；缺损大小超过内侧壁和下壁的三分之一；以及 Jaquiéry 分类 III 级或更高级别。回顾性评估并比较了研究组患者的特征、骨折缺损和手术细节、术后结果以及假体位置。
共纳入 19 例患者：5 例使用两件式 PSI，14 例使用商业假体。两件式 PSI 组的 4/5 例患者和商业假体组的 2/14 例患者的假体位置良好。与两件式 PSI 组相比，商业假体组的翻修手术、眼球位置异常（GMP）>2mm、明显复视和假体位置不良更为常见。假体位置总体良好的患者均无明显术后症状。
广泛眶骨骨折重建较为少见，手术治疗相关并发症和术后症状发生率较高。钛铣削的两件式 PSI 非常适合 EOFMF 的初次重建，与市售假体相比，其导致的重建更精确，术后症状更少。
