Clinical Outcomes for Minimally Invasive Primary and Secondary Orbital Reconstruction using an Advanced Synergistic Combination of Navigation and Endoscopy

Publication date: Available online 24 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Chien-Tzung Chen, Chun–Hao Pan, Chih-Hao Chen, Victor Bong-Han Shyu, John Chung-Han Wu, Gavin Chun-Wui Kang
BackgroundSequelae of inadequate orbital reconstruction include enophthalmos, hypoglobus, and diplopia. Accuracy of orbital reconstruction is largely subjective and especially difficult to achieve due to anatomic distortion in secondary or late reconstruction and in extensive injury. We combined computer navigation and endoscopy to perform accurate, aesthetic, and safe minimal-access primary and secondary orbital reconstruction.MethodsFrom 2013 to 2014, 24 patients underwent unilateral primary and secondary or late minimally-invasive orbital reconstruction with mainly Medpor and/or titanium mesh via navigation and endoscopic assistance through transantral, transconjunctival or upper blepharoplasty approaches. Mean follow-up was 13.8 months (range, 6.2 months to 2.8 years).ResultsAll orbital fractures were successfully reduced. Average enophthalmos among patients who underwent early reconstruction, late reconstruction, and multi-orbital-wall repair improved (P < .001) to 0.2 mm from 1.6 mm, 2.6 mm, 2.6 mm respectively. Hypoglobus and diplopia resolved in all. In early reconstruction patients, mean inter-orbital volume difference improved from 1.72±0.87 ml to 0.53±0.83 ml (P = .03). For late reconstruction patients, this difference improved from 3.41±1.23 ml to 0.56±0.96 ml (P < .001). There were no major complications during follow-up and all were satisfied with their final appearance and function.ConclusionNavigation sharpens reconstructive accuracy and avoids injury to vital structures. Combined with endoscopic assistance for minimal-access reconstruction of wide-ranging orbital defects from primary to secondary or late cases and to extensive multi-wall fractures, navigation facilitates minimal cosmetic incision and synergistic endoscope use, and clearly optimizes aesthetic and functional outcomes all with enhanced safety and unparalleled intraoperative visualization.



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