Page 146 - Advanced concepts in orbital wall fractures

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Chapter 8
In chapter 5, the effects of intraoperative CT imaging in orbital reconstruction are discussed. It enables the surgeon to check and adjust the position of the implant during surgery. The same ten cadavers from the aforementioned cadaver study are used. A CT scan is acquired during the reconstruction and the implant is adjusted if necessary. The CT scans are repeated until the surgeon is satisfied. The position of the implant is compared to the ideal position and yaw and roll improve significantly (p<0.05). On average, 1.6 scans are required to achieve the desired result and the main reason for alteration is the rotation roll. The significant improvement in the position of the implant and the possible prevention of revision surgery could outweigh the disadvantages, which include extra radiation exposure, increased operation time, and added costs.
The management of orbital fractures is still open for discussion as there is no widely accepted clinical protocol. The results of an updated clinical protocol for orbital wall fractures are presented in chapter 6. The emphasis is placed on nonsurgical treatment, frequent orthoptic measurements, and a multidisciplinary approach. In the prospective cohort study, patients underwent clinical assessment and orthoptic evaluation up to 12 months after trauma or surgery. Most patients (46 out of 58) received nonsurgical treatment. Results demonstrated that 45 out of all 58 patients had an excellent outcome and the other patients had limited diplopia. The average quality-of-life score at the end of follow- up was 97 out of 100. Late enophthalmos did not develop in any of the patients. Based on these results, it can be stated that the body has a good regenerative capacity and that most orbital wall fractures benefit from a nonsurgical approach with adequate orthoptic evaluation.
In chapter 7, all findings are combined and evaluated in the general discussion and a perspective for the future is provided. All diagnostic and preoperative components of CAS are available with solely specialised software. The results of this thesis indicate substantial added value of virtual diagnostics and preoperative planning using 3D software. These tools are relatively easy to use and affordable to implement in general clinics. They improve clinical care and can be used for teaching and research purposes. The combination of virtual preoperative planning and