Page 136 - Advanced concepts in orbital wall fractures

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Chapter 7
they are unable to recover by themselves. The chance of these patients recovering without symptoms after surgery is poor. This may be due to a more complex fracture. The theory is that with delayed reconstruction adhesion and fibrosis complicate the reconstruction, which in turn could cause secondary trauma with possibly worse outcomes. There is insufficient and low-quality data to provide a basis for guidelines25.
The following can be concluded from the results of our study:
1. Diplopia and limited eye motility have the potential to recover
after an orbital wall fracture.
2. The occurrence of late enophthalmos (>2 mm) is rare after
nonsurgical treatment of large orbital wall fractures.
3. Good results are achieved with a predominantly nonsurgical
approach and this is justified for most orbital wall fractures.
4. A multidisciplinary approach is beneficial to acquire more
knowledge about the prevailing issues.
Future perspectives
Computer-assisted surgery (CAS) in orbital reconstruction already ensures a high level of accuracy and predictability. Apart from substantial cost reductions, further optimisation and improved user-friendliness will enable the mainstream use of the CAS components in general clinics. Time efficiency could be improved as the automation of several components, such as automatic recognition of the fracture complexity, is possible with new promising techniques. The next step in CAS is implant-oriented navigation for better intraoperative control of complex fractures26. Augmented reality can be used for training purposes and may facilitate intraoperative highlighting of the anatomical landmarks. The combination of implant-oriented navigation and augmented reality enables the virtual projection of the planned position of the implant, eliminating the need for the surgeon to look at the multiplanar view on a computer screen27. The use of robotics is probably something for the distant future. Robotics can assist in the final positioning and stabilisation during fixation of the implant. For all technologies mentioned, it remains