scholarly journals Orbital Fractures

2021 ◽  
pp. 1201-1250
Author(s):  
Ananthanarayanan Parameswaran ◽  
Madhulaxmi Marimuthu ◽  
Shreya Panwar ◽  
Beat Hammer
Keyword(s):  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Computer Assisted ◽  
Management Options ◽  
Orbital Trauma ◽  
Young Surgeon ◽  
Patient Specific Implants ◽  
Clinical Overview

AbstractSurgery for orbital trauma is challenging. A good understanding of the orbit, its normal form, function, and the varying patterns of its disruption due to trauma is essential for its proper management. The aim of this chapter is to provide a comprehensive clinical overview of all facets of orbital trauma for the young surgeon. The chapter has been structured to include the basics of (i) anatomy, (ii) biomechanics of injury, (iii) classification and their clinical implications, (iv) surgical approaches and (v) management options available for individual types of fractures. Special features of this chapter include descriptions of clinical features exclusive to orbital trauma with a section for management of orbital emergencies. A detailed note is provided for the management of fractures of the orbital floor including guidelines for deep orbital dissection and elaboration of the principles of reconstruction. The role of computer assisted surgery, intra-operative navigation and patient specific implants has also been added to explain the recent advances in this field of surgery.

scholarly journals Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

2021 ◽  
Vol 11 ◽  
Author(s):  
Henriette L. Möllmann ◽  
Laura Apeltrath ◽  
Nadia Karnatz ◽  
Max Wilkat ◽  
Erik Riedel ◽  
...  
Keyword(s):  
Computer Assisted Surgery ◽  
Reference Points ◽  
Mandibular Reconstruction ◽  
Patient Specific ◽  
Computer Assisted ◽  
Advantages And Disadvantages ◽  
Patient Specific Implants ◽  
Operative Complications ◽  
The Difference ◽  
And Training

ObjectivesThis retrospective study compared two mandibular reconstruction procedures—conventional reconstruction plates (CR) and patient-specific implants (PSI)—and evaluated their accuracy of reconstruction and clinical outcome.MethodsOverall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences.ResultsIn the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 <.05]. In the CR group, the difference was 1.5 (SD = 3.9) and in the PSI group -1.04 (SD = 4.9). CR did not demonstrate a higher risk of plate fractures and post-operative complications compared to PSI.ConclusionFor reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.

scholarly journals Computer-Assisted Secondary Orbital Reconstruction

2020 ◽  
pp. 194338752093500
Author(s):  
Daman D. Singh ◽  
Lara Schorn ◽  
E. Bradley Strong ◽  
Michael Grant ◽  
Alexander Schramm ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Data Sets ◽  
Orbital Reconstruction ◽  
Secondary Reconstruction ◽  
Patient Specific Implants ◽  
Before And After ◽  
Secondary Orbital Reconstruction

Study Design: This study presents a case-control study of 33 patients who underwent secondary orbital reconstruction, evaluating techniques and outcome. Objective: Adequate functional and aesthetical appearance are main goals for secondary orbital reconstruction. Insufficient premorbid orbital reconstruction can result in hypoglobus, enophthalmos, and diplopia. Computer-assisted surgery and the use of patient-specific implants (PSIs) is widely described in the literature. The authors evaluate the use of selective laser-melted PSIs and hypothesize that PSIs are an excellent option for secondary orbital reconstruction. Methods: The sample was composed of 33 patients, previously treated with primary orbital reconstruction, presenting themselves with indications for secondary reconstruction (i.e. enophthalmos, diplopia, or limited eye motility). Computed tomography and/or cone beam data sets were assessed before and after secondary reconstruction comparing intraorbital volumes, infraorbital angles, and clinical symptoms. Clinical outcomes were assessed using a standardized protocol. Results: Results show a significant change in intraorbital volumes and a reduction of clinical symptoms after secondary reconstruction. Conclusions: Outcomes of this study suggest that secondary orbital reconstruction can be performed routinely using selective laser-melted PSIs and titanium spacers.

Craniofacial Reconstruction Using Patient-Specific Implants Polyether Ether Ketone With Computer-Assisted Planning

2015 ◽  
Vol 26 (3) ◽  
pp. 663-666 ◽  
Author(s):  
Oscar J. Manrique ◽  
Frank Lalezarzadeh ◽  
Erez Dayan ◽  
Joseph Shin ◽  
Daniel Buchbinder ◽  
...  
Keyword(s):  
Patient Specific ◽  
Computer Assisted ◽  
Craniofacial Reconstruction ◽  
Patient Specific Implants ◽  
Polyether Ether Ketone ◽  
Ether Ketone

scholarly journals Accuracy of Patient Specific Cutting Blocks in Total Knee Arthroplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Naeder Helmy ◽  
Mai Lan Dao Trong ◽  
Stefanie P. Kühnel
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Assisted Surgery ◽  
Tibial Slope ◽  
Patient Specific ◽  
Computer Assisted ◽  
Success Rates ◽  
Term Survival ◽  
Margin Of Error ◽  
Total Knee

Background.Long-term survival of total knee arthroplasty (TKA) is mainly determined by optimal positioning of the components and prosthesis alignment. Implant positioning can be optimized by computer assisted surgery (CAS). Patient specific cutting blocks (PSCB) seem to have the potential to improve component alignment compared to the conventional technique and to be comparable to CAS.Methods.113 knees were selected for PSI and included in this study. Pre- and postoperative mechanical axis, represented by the hip-knee-angle (HKA), the proximal tibial angle (PTA), the distal femoral angle (DFA), and the tibial slope (TS) were measured and the deviation from expected ideal values was calculated.Results.With a margin of error of ±3°, success rates were 81.4% for HKA, 92.0% for TPA, and 94.7% for DFA. With the margin of error for alignments extended to ±4°, we obtained a success rate of 92.9% for the HKA, 98.2% for the PTA, and 99.1% for the DFA. The TS showed postoperative results of 2.86 ± 2.02° (mean change 1.76 ± 2.85°).Conclusion.PSCBs for TKA seem to restore the overall leg alignment. Our data suggest that each individual component can be implanted accurately and the results are comparable to the ones in CAS.

Orthopaedics

2018 ◽  
Author(s):  
Nev Davies ◽  
Anuhya Vusirikala
Keyword(s):  
New Technology ◽  
Computer Assisted Surgery ◽  
Developmental Dysplasia ◽  
First Century ◽  
Computer Assisted ◽  
Management Options ◽  
Hip Replacements ◽  
Paediatric Orthopaedic ◽  
The Uk

Over the years, orthopaedic surgery has evolved into a vast specialty that is ever growing, with new technology, techniques, and implants. Computer-assisted surgery and minimally invasive approaches are current hot topics that are pushing the boundaries of what constitutes gold standard care for patients. This specialty touches people of all ages from all walks of life. The practicality and logic in decision-making and management appeal to today’s modern ‘orthopods’. Common paediatric orthopaedic conditions, such as developmental dysplasia of the hip and septic arthritis, can have serious consequences for the rest of the child’s life if unrecognized and so are represented in this chapter. Arthroplasty has been one of the true successes of the twenty-first century, and now over 160 000 knee and hip replacements are performed each year in the UK, revolutionizing the quality of life of patients with painful disabling arthritis. To be a good orthopaedic surgeon requires not only a wide knowledge base, but also common sense, logic, and practical skills. ‘A good surgeon knows how to operate; a great surgeon knows when to operate’ is a classic saying that was drilled into me as a young houseman. In this specialty, there are often several management options facing the surgeon and the patient, and through careful discussion and the process of informed consent, a joint plan can be formulated and executed. The questions in this chapter will help you to prepare both for your exams and for a future career as a doctor.

scholarly journals Accuracy of Coronal Plane Mechanical Alignment in a Customized, Individually Made Total Knee Replacement with Patient-Specific Instrumentation

2017 ◽  
Vol 31 (08) ◽  
pp. 792-796 ◽  
Author(s):  
Gary Levengood ◽  
Jack Dupee
Keyword(s):  
Mechanical Axis ◽  
Computer Assisted Surgery ◽  
Coronal Plane ◽  
Patient Specific ◽  
Computer Assisted ◽  
Consecutive Series ◽  
Mechanical Alignment ◽  
Patient Specific Instrumentation ◽  
Patient Specific Instruments ◽  
Total Knee

AbstractThe objective of this study was to evaluate the accuracy of a customized individually made total knee implant used in conjunction with patient-specific cutting guides in restoring coronal plane mechanical axis alignment using computer-assisted surgery (CAS). A consecutive series of 63 total knee arthroplasty (TKA) patients were prospectively measured with intraoperative CAS. The patient-specific instruments and implants were created utilizing a preoperative CT scan. CAS system was used for all patients, to determine mechanical alignment. Bone cuts were made using the patient-specific instruments. Both bone cuts and final coronal mechanical alignment were recorded utilizing the navigation system for the assessment.The patient-specific instruments and implants provided perfect neutral coronal mechanical alignment (0°) in 53 patients. The remaining 10 patients had a postoperative alignment within ± 2° of neutral. The average preoperative deformity was 5.57° versus 0.18° postoperatively (p < 0.0001). The mean correction angle was 5.68°. No patients had postoperative extension deficits as measured with CAS (7.50° pre-op for 40/63 patients). Customized, individually made total knee implant with patient-specific cutting jigs showed results that are comparable to those of CAS systems in this study. This technology restores the neutral coronal mechanical axis very accurately, while offering unique benefits such as improved implant fit and restoration of the patient's J-curves, which require further investigation.

scholarly journals A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sarah E. Bosma ◽  
Kwok Chuen Wong ◽  
Laurent Paul ◽  
Jasper G. Gerbers ◽  
Paul C. Jutte
Keyword(s):  
Computer Navigation ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Oncologic Surgery ◽  
Engineering Software ◽  
Patient Specific Instrumentation ◽  
Quality Control Tool ◽  
Patient Specific Instruments ◽  
Intraoperative Quality Control

Orthopedic oncologic surgery requires preservation of a functioning limb at the essence of achieving safe margins. With most bone sarcomas arising from the metaphyseal region, in close proximity to joints, joint-salvage surgery can be challenging. Intraoperative guidance techniques like computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) could assist in achieving higher surgical accuracy. This study investigates the surgical accuracy of freehand, CAS- and PSI-assisted joint-preserving tumor resections and tests whether integration of CAS with PSI (CAS + PSI) can further improve accuracy. CT scans of 16 simulated tumors around the knee in four human cadavers were performed and imported into engineering software (MIMICS) for 3D planning of multiplanar joint-preserving resections. The planned resections were transferred to the navigation system and/or used for PSI design. Location accuracy (LA), entry and exit points of all 56 planes, and resection time were measured by postprocedural CT. Both CAS + PSI- and PSI-assisted techniques could reproduce planned resections with a mean LA of less than 2 mm. There was no statistical difference in LA between CAS + PSI and PSI resections (p=0.92), but both CAS + PSI and PSI showed a significantly higher LA compared to CAS (p=0.042 and p=0.034, respectively). PSI-assisted resections were faster compared to CAS + PSI (p<0.001) and CAS (p<0.001). Adding CAS to PSI did improve the exit points, however not significantly. In conclusion, PSI showed the best overall surgical accuracy and is fastest and easy to use. CAS could be used as an intraoperative quality control tool for PSI, and integration of CAS with PSI is possible but did not improve surgical accuracy. Both CAS and PSI seem complementary in improving surgical accuracy and are not mutually exclusive. Image-based techniques like CAS and PSI are superior over freehand resection. Surgeons should choose the technique most suitable based on the patient and tumor specifics.

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