Computer-Assisted Design and Manufacture of Implants in the Late Reconstruction of Extensive Orbital Fractures

OBJECTIVE: To evaluate the use of computer-assisted designed and manufactured (CAD/CAM) orbital wall and floor implants for late reconstruction of extensive orbital fractures. METHODS: We performed a retrospective data review on 29 patients treated for extensive orbital fractures from January 1, 1997, through December 31, 2007, at the University College London Hospitals. The use of a CAD/CAM technique based on cross-sectional computed tomographic scans, generating an accurate stereolithographic model, enabled surgeons and technicians to plan and create the best dimension and position of the implant. Sheet titanium was then pressed to shape from a design outlined on a counterdie of the new reconstructed model. RESULTS: Twenty-nine patients with late enophthalmos due to complex orbital fractures underwent successful reconstruction surgery. Enophthalmos was corrected in all patients. Diplopia was improved in 14 patients, and extraocular movement was improved in 13. CONCLUSIONS: The CAD/CAM implants represent a financially viable method for secondary reconstruction of the orbit. This method enables the surgeon to plan the operation in detail, facilitates the surgical procedure, and can help to improve the outcome.