He Brandon, Kim Yewon, Ngo Quan
From the School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.
Department of Plastic and Reconstructive Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia.
Plast Reconstr Surg Glob Open. 2025 May 5;13(5):e6772. doi: 10.1097/GOX.0000000000006772. eCollection 2025 May.
The mechanism and physiology of orbital cavity remodeling after orbital fractures is not well described. This poses a challenge in the delayed operative treatment of orbital floor fractures due to variations from expected anatomy and may risk injury to critical structures during exploration as well as misguided reconstruction, causing persistent ocular dystopia. We report a case where significant orbital remodeling caused unexpected challenges to orbital floor reconstruction, highlighting the need for further research in this field. A 23-year-old previously healthy man was treated conservatively for a left orbital floor fracture sustained during a rugby match. At a 4-month follow-up, the patient was found to have significant ocular dystopia with vertical diplopia and cosmetically significant enophthalmos. A discrepancy of 4 mm was noted on exophthalmometry. Intraoperatively, the neo-floor was found to have fully healed but with significant downsloping angulation and clinically appreciable depression. Furthermore, no fracture ledges were able to be used to guide the height of the titanium reconstruction plate, posing a significant challenge. Therefore, a 3-dimensional printed model of the orbit using a recent computed tomography scan was used to conform the plate to the required dimensions. The patient made a good recovery without ocular symptoms. Fracture remodeling of the orbital cavity is poorly described and may not be considered in the delayed treatment of orbital fractures. Further research to describe the mechanism and pattern of how this occurs is necessary. Computer-assisted design with 3-dimensional printing is a useful tool that can help overcome technical challenges in complex maxillofacial cases.
眼眶骨折后眼眶重塑的机制和生理学尚未得到充分描述。这给眼眶底骨折的延迟手术治疗带来了挑战，因为实际解剖结构与预期存在差异，在探查过程中可能会损伤关键结构，还可能导致重建方向错误，从而引起持续性眼球错位。我们报告了一例因显著的眼眶重塑给眼眶底重建带来意外挑战的病例，强调了该领域进一步研究的必要性。一名23岁既往健康的男性在一场橄榄球比赛中左侧眼眶底骨折，接受了保守治疗。在4个月的随访中，发现该患者存在明显的眼球错位，伴有垂直复视和具有明显美容缺陷的眼球内陷。眼球突出度测量显示相差4毫米。术中发现新形成的眶底已完全愈合，但有明显的向下倾斜角度和临床上可察觉到的凹陷。此外，没有骨折边缘可用于指导钛重建板的高度，这带来了重大挑战。因此，利用近期的计算机断层扫描构建了眼眶的三维打印模型，以使重建板符合所需尺寸。患者恢复良好，无眼部症状。眼眶腔的骨折重塑情况描述甚少，在眼眶骨折的延迟治疗中可能未被考虑。有必要进一步研究其发生机制和模式。计算机辅助设计与三维打印是一种有用的工具，可帮助克服复杂颌面病例中的技术挑战。
