Resident, Department of Oral & Maxillofacial Surgery, MGM Dental College & Hospital, Navi Mumbai, Maharashtra, India.
Dean, Professor and Head, Department of Oral & Maxillofacial Surgery, MGM Dental College & Hospital, Navi Mumbai, Maharashtra, India.
J Oral Maxillofac Surg. 2024 Jul;82(7):806-819. doi: 10.1016/j.joms.2024.03.031. Epub 2024 Apr 2.
This review aims to compare and evaluate the outcomes achieved by integrating technological aids and the influence of different implant designs in the reconstruction of post-traumatic orbital defects.
Electronic searches of the MEDLINE, Embase, Cochrane Library, and Google Scholar databases until March 2023 were conducted. Clinical controlled trials, observational studies, cohort studies, and retrospective studies were identified and included. The predictor variables were the integration of technological aids namely, computer-assisted surgical planning, mirror image overlay, and intraoperative navigation with the utilization of different orbital implant designs (standard orbital meshes, preformed implants, prebent implants, and patient-specific implant [PSI]) during post-traumatic orbital reconstruction. The primary outcome variables were orbital volume, diplopia, and enophthalmos. Weighted or mean difference and risk ratios at 95% confidence intervals were calculated, where P ＜ .05 was considered significant and a random effects model was adopted.
This review included 7 studies with 560 participants. The results indicate that the difference in postoperative orbital volume between affected and nonaffected eye showed no statistically significant difference between PSI and prebent group (mean difference, -0.41 P = .28, I = 46%). PSI group resulted in diplopia 0.71-fold less than that of the standard orbital mesh group but was not statistically significant (P = .15). Standard orbital mesh group is 0.30 times at higher risk of developing enophthalmos as compared to PSI group (P = .010). The literature suggests PSIs are preferred for patients with large defects (Jaquiéry's III-IV), whereas prebent implants are equally effective as PSIs in patients with preserved infraorbital buttress and retrobulbar bulge.
PSIs are associated with improved outcomes, especially for correcting enophthalmos. The data suggests the potential efficacy of prebent implants and PSIs in orbital volume corrections. There is a lack of randomized studies. This review should serve as a recommendation for further studies to contribute to the existing literature.
本综述旨在比较和评估整合技术辅助手段和不同植入物设计在创伤后眼眶缺损重建中的应用效果。
对 MEDLINE、Embase、Cochrane 图书馆和 Google Scholar 数据库进行了截至 2023 年 3 月的电子检索。确定并纳入了临床对照试验、观察性研究、队列研究和回顾性研究。预测变量为整合技术辅助手段，即计算机辅助手术规划、镜像叠加和术中导航，以及在创伤后眼眶重建中使用不同的眼眶植入物设计（标准眼眶网、预制植入物、预弯植入物和患者特异性植入物[PSI]）。主要结局变量为眼眶容积、复视和眼球内陷。计算了 95%置信区间的加权或平均值差异和风险比，其中 P＜0.05 被认为具有统计学意义，并采用随机效应模型。
本综述纳入了 7 项研究，共计 560 名参与者。结果表明，PSI 组与预弯组之间受影响眼和未受影响眼术后眼眶容积的差异无统计学意义（平均差异，-0.41，P=0.28，I=46%）。PSI 组发生复视的风险比标准眼眶网组低 0.71 倍，但无统计学意义（P=0.15）。与 PSI 组相比，标准眼眶网组发生眼球内陷的风险高 0.30 倍（P=0.010）。文献表明，PSI 更适用于大缺损（Jaquiéry's III-IV）的患者，而预弯植入物在保存眶下壁和眶后膨出的患者中与 PSI 同样有效。
PSI 与改善结局相关，尤其是在矫正眼球内陷方面。数据表明，预弯植入物和 PSI 在眼眶容积矫正方面具有潜在的疗效。目前缺乏随机研究。本综述应作为进一步研究的建议，以丰富现有文献。
