Fawzy Hossam Hassan, Saber Ahmed Fergany, Nassar Ahmed Tharwat, Eid Khaled Adel, Ghareeb Fouad Mohamed
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
J Craniomaxillofac Surg. 2022 Dec;50(12):873-883. doi: 10.1016/j.jcms.2023.01.002. Epub 2023 Jan 7.
The aim of this study was to evaluate the clinical outcomes of linear and orbital volume measurements in severe orbital trauma. Patients with severe orbital trauma that involved more than two walls and entailed a marked degree of comminution were included in this retrospective analysis. However, patients with incomplete clinical records and a simple blowout or zygmatico-orbital fractures were excluded. All the cases underwent surgical correction guided by virtual surgical planning and 3D-printed templates. The measurement protocol depended on assessing orbital dimensions, orbital volumetry, and the zygomatic bone's position in the three-dimensional planes. All patients' preoperative 3D CT scans were obtained, and DICOM files were imported into a three-dimensional image processing software. Data were then converted for 3D reconstruction in the axial, coronal, and sagittal views. A total of 18 patients with a mean age was 39.28 ± 6.28 were included in this study. The results revealed a significant difference between the pre and postoperative differences in distances in relation to the FHP (Frankfurt Horizontal Plane) (P = 0.0014) and sagittal planes (P < 0.0001). The orbital width and height of the traumatized orbit were significantly decreased from 45.26 ± 6.72 mm and 45.30 ± 2.89 mm to 39.74 ± 3.91 mm (P = 0.0022), and 40.34 ± 0.86 mm (P < 0.0001), respectively. Clinically, there was a satisfactory degree of symmetry regarding the zygomatic bones' position and orbital dimensions postoperatively. Moreover, the mean orbital volume on the traumatized side decreased significantly from 23.16 ± 1.91 cm preoperatively to 20.7 ± 1.96 cm postoperatively (P < 0.0001). These findings were associated with a low incidence of complications. Within the limitations of the study it seems that the described methodology is a relevant addition to clinical treatment options. It incorporates all the latest technology to plan virtual reconstruction surgery in the treatment of complex orbital trauma and should be adapted accordingly in cases of severe displacement and comminution.
本研究的目的是评估严重眼眶创伤中线性和眼眶容积测量的临床结果。本回顾性分析纳入了涉及超过两壁且伴有明显粉碎程度的严重眼眶创伤患者。然而，临床记录不完整以及单纯爆裂性或颧眶骨折的患者被排除在外。所有病例均在虚拟手术规划和3D打印模板的引导下进行手术矫正。测量方案取决于评估眼眶尺寸、眼眶容积以及颧骨在三维平面中的位置。获取了所有患者的术前3D CT扫描图像，并将DICOM文件导入三维图像处理软件。然后将数据转换为轴向、冠状和矢状视图的3D重建图像。本研究共纳入18例患者，平均年龄为39.28±6.28岁。结果显示，术前与术后相对于法兰克福水平面（FHP）的距离差异（P = 0.0014）以及矢状面差异（P < 0.0001）具有统计学意义。受伤眼眶的眶宽和眶高分别从45.26±6.72毫米和45.30±2.89毫米显著降低至39.74±3.91毫米（P = 0.0022）和40.34±0.86毫米（P < 0.0001）。临床上，术后颧骨位置和眼眶尺寸的对称程度令人满意。此外，受伤侧的平均眼眶容积术前为23.16± 1.91立方厘米，术后显著降至20. 7±1.96立方厘米（P < 0.0001）。这些结果与并发症发生率较低相关。在本研究的局限性范围内，所描述的方法似乎是临床治疗选择的一个有益补充。它整合了所有最新技术，用于规划复杂眼眶创伤治疗中的虚拟重建手术，并且在严重移位和粉碎的情况下应相应调整。
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