Saini Parampreet Singh, Kumar Rajesh, Saini Manu, Gupta Tarush, Gaba Sunil, Sharma Ramesh Kumar
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Arch Craniofac Surg. 2024 Aug;25(4):161-170. doi: 10.7181/acfs.2024.00143. Epub 2024 Aug 20.
The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction.
A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia.
Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm3; interquartile range [IQR], 28.45-30.64) was comparable to that of the reconstructed orbit (29.67 cm3; IQR, 27.92-31.52). Diplopia improved significantly (T(10) = 2.667, p = 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1-2 mm), and one experienced implant impingement at the infraorbital border.
Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction.
眼睛是面部的核心美学单元。颌面创伤会改变面部比例，并不同程度地影响视觉功能。传统的重建方法存在诸多局限性，使得该过程具有挑战性。本研究的主要目的是评估三维（3D）导航在复杂单侧眼眶重建中的应用。
进行了一项为期19个月（2020年1月至2021年7月）的前瞻性队列研究，连续纳入12名符合纳入标准的患者。每位患者至少随访6个月。主要研究者对骨折形态、眼眶容积、眼球突出度、复视、面部形态变化、眼睑退缩和眶下神经感觉减退等几个因素进行了比较分析。
9例患者为不纯性眼眶骨折，其余为单纯骨折。正常侧眼眶容积中位数（30.12 cm³；四分位间距[IQR]，28.45 - 30.64）与重建眼眶（29.67 cm³；IQR，27.92 - 31.52）相当。复视有显著改善（T(10) = 2.667，p = 0.02），尽管眼球突出度无统计学显著改善。面部标志点实现了大致对称，面部宽高比和睑裂长度相当。2例患者在就诊时报告有眶下感觉减退，在6个月随访时仍持续存在。此外，5例患者出现下睑退缩（1 - 2 mm），1例在眶下缘出现植入物撞击。
我们的研究提供了二级证据，支持使用3D导航改善复杂眼眶重建的手术效果。
