Functional and Cosmetic Outcome after Reconstruction of Isolated, Unilateral Orbital Floor Fractures (Blow-Out Fractures) with and without the Support of 3D-Printed Orbital Anatomical Models

The present study aimed to analyze if a preformed “hybrid” patient-specific orbital mesh provides a more accurate reconstruction of the orbital floor and a better functional outcome than a standardized, intraoperatively adapted titanium implant. Thirty patients who had undergone surgical reconstruction for isolated, unilateral orbital floor fractures between May 2016 and November 2018 were included in this study. Of these patients, 13 were treated conventionally by intraoperative adjustment of a standardized titanium mesh based on assessing the fracture’s shape and extent. For the other 17 patients, an individual three-dimensional (3D) anatomical model of the orbit was fabricated with an in-house 3D-printer. This model was used as a template to create a so-called “hybrid” patient-specific titanium implant by preforming the titanium mesh before surgery. The functional and cosmetic outcome in terms of diplopia, enophthalmos, ocular motility, and sensory disturbance trended better when “hybrid” patient-specific titanium meshes were used but with statistically non-significant differences. The 3D-printed anatomical models mirroring the unaffected orbit did not delay the surgery’s timepoint. Nonetheless, it significantly reduced the surgery duration compared to the traditional method (58.9 (SD: 20.1) min versus 94.8 (SD: 33.0) min, p-value = 0.003). This study shows that using 3D-printed anatomical models as a supporting tool allows precise and less time-consuming orbital reconstructions with clinical benefits.

Download Full-text

Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and “Hybrid” Patient-Specific Implants

Journal of Clinical Medicine ◽

10.3390/jcm9051579 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1579 ◽

Cited By ~ 1

Author(s):

Guido R. Sigron ◽

Nathalie Rüedi ◽

Frédérique Chammartin ◽

Simon Meyer ◽

Bilal Msallem ◽

...

Keyword(s):

Intervention Group ◽

Three Dimensional ◽

Orbital Floor ◽

Patient Specific ◽

Titanium Mesh ◽

Patient Specific Implants ◽

Absolute Volume ◽

Orbital Floor Fractures ◽

3D Printed ◽

Volume Difference

The aim of this study was to compare the efficacy of the intraoperative bending of titanium mesh with the efficacy of pre-contoured “hybrid” patient-specific titanium mesh for the surgical repair of isolated orbital floor fractures. In-house 3D-printed anatomical models were used as bending guides. The main outcome measures were preoperative and postoperative orbital volume and surgery time. We performed a retrospective cohort study including 22 patients who had undergone surgery between May 2016 and November 2018. The first twelve patients underwent conventional reconstruction with intraoperative free-hand bending of an orbital floor mesh plate. The subsequent ten patients received pre-contoured plates based on 3D-printed orbital models that were produced by mirroring the non-fractured orbit of the patient using a medical imaging software. We compared the preoperative and postoperative absolute volume difference (unfractured orbit, fractured orbit), the fracture area, the fracture collapse, and the effective surgery time between the two groups. In comparison to the intraoperative bending of titanium mesh, the application of preformed plates based on a 3D-printed orbital model resulted in a non-significant absolute volume difference in the intervention group (p = 0.276) and statistically significant volume difference in the conventional group (p = 0.002). Further, there was a significant reduction of the surgery time (57.3 ± 23.4 min versus 99.8 ± 28.9 min, p = 0.001). The results of this study suggest that the use of 3D-printed orbital models leads to a more accurate reconstruction and a time reduction during surgery.

Download Full-text

Management of Orbital Floor Fractures

Facial Plastic Surgery ◽

10.1055/s-0039-1700852 ◽

2019 ◽

Vol 35 (06) ◽

pp. 633-639 ◽

Cited By ~ 1

Author(s):

Tom Shokri ◽

Mark Alford ◽

Matthew Hammons ◽

Yadranko Ducic ◽

Mofiyinfolu Sokoya

Keyword(s):

Decision Making ◽

Surgical Repair ◽

Operative Intervention ◽

Orbital Floor ◽

Ocular Motility ◽

Orbital Volume ◽

Facial Contour ◽

Orbital Floor Fractures ◽

Craniomaxillofacial Trauma

AbstractFractures of the orbital floor represent a common yet difficult to manage sequelae of craniomaxillofacial trauma. Repair of these injuries should be carried out with the goal of restoring normal orbital volume, facial contour, and ocular motility. Precise surgical repair is imperative to reduce the risk of long-term debilitating morbidity. This article aims to review concepts on the management of orbital floor fractures in the hope of further elucidating perioperative evaluation and decision-making regarding operative intervention.

Download Full-text

Anatomical 3-dimensional Pre-bent Titanium Implant for Orbital Floor Fractures

Ophthalmology ◽

10.1016/j.ophtha.2006.03.062 ◽

2006 ◽

Vol 113 (10) ◽

pp. 1863-1868 ◽

Cited By ~ 74

Author(s):

Marc C. Metzger ◽

Ralf Schön ◽

Nils Weyer ◽

Amir Rafii ◽

Nils-Claudius Gellrich ◽

...

Keyword(s):

Titanium Implant ◽

Orbital Floor ◽

3 Dimensional ◽

Orbital Floor Fractures

Download Full-text

Custom Patient-Specific Three-Dimensional Printed Mitral Valve Models for Pre-Operative Patient Education Enhance Patient Satisfaction and Understanding

Journal of Medical Devices ◽

10.1115/1.4043737 ◽

2019 ◽

Vol 13 (3) ◽

Author(s):

Kay S. Hung ◽

Michael J. Paulsen ◽

Hanjay Wang ◽

Camille Hironaka ◽

Y. Joseph Woo

Keyword(s):

Patient Education ◽

Mitral Valve ◽

Three Dimensional ◽

3D Models ◽

Patient Specific ◽

Imaging Data ◽

Anatomical Models ◽

Mitral Valves ◽

Flexible Polymer ◽

3D Printed

In recent years, advances in medical imaging and three-dimensional (3D) additive manufacturing techniques have increased the use of 3D-printed anatomical models for surgical planning, device design and testing, customization of prostheses, and medical education. Using 3D-printing technology, we generated patient-specific models of mitral valves from their pre-operative cardiac imaging data and utilized these custom models to educate patients about their anatomy, disease, and treatment. Clinical 3D transthoracic and transesophageal echocardiography images were acquired from patients referred for mitral valve repair surgery and segmented using 3D modeling software. Patient-specific mitral valves were 3D-printed using a flexible polymer material to mimic the precise geometry and tissue texture of the relevant anatomy. 3D models were presented to patients at their pre-operative clinic visit and patient education was performed using either the 3D model or the standard anatomic illustrations. Afterward, patients completed questionnaires assessing knowledge and satisfaction. Responses were calculated based on a 1–5 Likert scale and analyzed using a nonparametric Mann–Whitney test. Twelve patients were presented with a patient-specific 3D-printed mitral valve model in addition to standard education materials and twelve patients were presented with only standard educational materials. The mean survey scores were 64.2 (±1.7) and 60.1 (±5.9), respectively (p = 0.008). The use of patient-specific anatomical models positively impacts patient education and satisfaction, and is a feasible method to open new opportunities in precision medicine.

Download Full-text

Combined Use of Titanium Mesh and Resorbable PLLA-PGA Implant in the Treatment of Large Orbital Floor Fractures

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3182319615 ◽

2011 ◽

Vol 22 (6) ◽

pp. 1991-1995 ◽

Cited By ~ 14

Author(s):

Fernando González Magaña ◽

Rodrigo Menéndez Arzac ◽

Laura De Hilario Avilés

Keyword(s):

Orbital Floor ◽

Titanium Mesh ◽

Combined Use ◽

Orbital Floor Fractures

Download Full-text

Beneath the Skin: Emulating human physiology using a novel bitmap-based “voxel” 3D-printing workflow.

10.26686/wgtn.17151335 ◽

2021 ◽

Author(s):

◽

Ana Morris

Keyword(s):

Medical Education ◽

3D Printing ◽

Biomedical Imaging ◽

Human Anatomy ◽

Patient Specific ◽

Imaging Data ◽

Anatomical Models ◽

Medical Communication ◽

Medical Models ◽

3D Printed

<p>Novel technologies that produce medical models which are synthetic equivalents to human tissue may forever change the way human anatomy and medicine are explored. Medical modelling using a bitmap-based additive manufacturing workflow offers exciting opportunities for medical education, informed consent practices, skills acquisition, pre-operative planning and surgical simulation. Moving medical data from the 2D-world to tactile, highly detailed 3D-printed anatomical models may significantly change how we comprehend the body; revamping everything – from medical education to clinical practice. Research Problem The existing workflow for producing patient-specific anatomical models from biomedical imaging data involves image thresholding and iso-surface extraction techniques that result in surface meshes (also known as objects or parts). This process restricts shape specification to one colour and density, limiting material blending and resulting in anatomically inequivalent medical models. So, how can the use of 3D-printing go beyond static anatomical replication? Imagine pulling back the layers of tissue to reveal the complexity of a procedure, allowing a family to understand and discuss their diagnosis. Overcoming the disadvantages of static medical models could be a breakthrough in the areas of medical communication and simulation. Currently, patient specific models are either rigid or mesh-based and, therefore, are not equivalents of physiology. Research Aim The aim of this research is to create tangible and visually compelling patient-specific prototypes of human anatomy, offering an insight into the capabilities of new bitmap-based 3D-printing technology. It proposes that full colour, multi-property, voxel-based 3D-printing can emulate physiology, creating a new format of visual and physical medical communication. Data Collection and Procedure For this study, biomedical imaging data was converted into multi-property 3D-printed synthetic anatomy by bypassing the conversion steps of traditional segmentation. Bitmap-based 3D-printing allows for the precise control over every 14-micron material droplet or “voxel”. Control over each voxel involves a process of sending bitmap images to a high-resolution and multi-property 3D-printer. Bitmap-based 3D-printed synthetic medical models – which mimicked the colour and density of human anatomy – were successfully produced. Findings This research presented a novel and streamlined bitmap-based medical modelling workflow with the potential to save manufacturing time and labour cost. Moreover, this workflow produced highly accurate models with graduated densities, translucency, colour and flexion – overcoming complexities that arise due to our body’s opaqueness. The presented workflow may serve as an incentive for others to investigate bitmap-based 3D-printing workflows for different manufacturing applications.</p>

Download Full-text