Orbital reconstruction by patient-specific implant printed in porous titanium: a retrospective case series of 12 patients

Publication date: Available online 12 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): JeanThomas Bachelet, Guillaume Cordier, Matthieu Porcheray, Jerome Bourlet, Arnaud Gleizal, Jean-Marc Foletti
PurposeThe purpose of this study was to evaluate orbital patient specific implant (PSI), directly printed in porous titanium for the reconstruction of complex orbital bone defects, from a series of 12 patients.Patients and MethodsThe investigators designed and implemented a case series. The sample consisted of patients with unilateral complex orbital bone loss. All patients received a porous titanium PSI implantation designed from healthy contralateral side (mirroring). The criteria analyzed were the functional result: enophthalmic correction, ocular motility correction, operative time, complications and operative revisions. The study was done between 2015 and 2017.ResultsThe sample was composed of 12 patients, the mean age of whom was 47 years (range: 13 to 70 years). Patients were followed for a mean 36 weeks post-operatively (range 4 to 100 weeks). Twelve of the twelve patients presented pre-operative enophthalmia, eight of the twelve patients presented pre-operative diplopia. The mean operating time was 71 minutes (range 60 to 200 minutes). For 8 patients, the follow-up was simple, 2 patients required a surgical revision with repositioning of the implant in front of an intraoperative malposition of the implant with aesthetic and / or functional disturbance and a malposition confirmed in the post-operative CT-scan, 1 patient required a withdrawal of his implant 7 months after the surgery in front of spheno-orbital meningioma recidivism (the implant was well positioned), 1 patient operated by sub-ciliary approach presented a post-operative ectropion.In our series of porous titanium orbital PSI without positioning guides, we found 17% of malpositions (2 patients, both patients who required a new intervention for repositioning).ConclusionThe results of this study suggest that porous titanium PSI could be a surgical option of choice for patients with complex orbital bone defect, in our series 17 % of our sample needed a second operation. There are several ways to improve these results, intraoperative navigation, or integrated positioning guides.



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