Page 133 - Advanced concepts in orbital wall fractures

General discussion and future perspectives
may also function as a tool in decision-making for a referral to a tertiary clinic if a preformed implant is undesirable and a patient-specific implant or intraoperative navigation is required.
The complete workflow of CAS is essential for intermediate to complex orbital wall fractures. Individual use of several software components already improves the clinical result and can be used for simple fractures, if the necessary hardware is unavailable, or when it is not possible to refer to a tertiary clinic. The components of CAS described in chapters 2 to 4 only require specialised software and no additional hardware. As a result, it is a relatively affordable and easy to implement technology to improve care in general clinics and it is also useful for educational and research purposes in teaching clinics. The cadaver study on the use of preoperative planning in orbital reconstruction demonstrates its important role in the workflow. Additionally, intraoperative navigation provides essential intraoperative feedback. Intraoperative control is lacking in the absence of surgical navigation. Intraoperative imaging can be used instead for the final assessment of the accuracy of the reconstruction during surgery.
Chapter 5 demonstrates that intraoperative imaging during orbital reconstruction significantly improves the position of the implant.
The surgeon is able to assess the rotations yaw and roll and adjust
accordingly. Improving the translation of the implant is more difficult to
accomplish. On average, the surgeon requires 1.6 CT scans to be satisfied C with the final position. Intraoperative imaging has the potential to prevent 7 revision surgery and a suboptimal position of the implant. The impact
of the disadvantages (extra radiation exposure, increased operation time, and costs) should also be considered14. The extent to which these disadvantages occur could decrease with the improved quality of cone beam (CB)CT imaging. Intraoperative imaging should ideally replace postoperative imaging, so that there is no increased radiation exposure. Recent research states that routine postoperative imaging is not warranted in the absence of clinical symptoms, as it has limited added value15,16. This may be different for intraoperative imaging, given the aforementioned advantages. Besides, much can be learned from both intra- and postoperative imaging in educational and research settings.
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