Page 19 - Advanced concepts in orbital wall fractures

Technological developments C1 The principles and limitations of orbital reconstruction have triggered technological developments in the past two decades. Even with a perfect
approach, a good overview of the anatomical landmarks, and the ideal
implant material, there is still a need for technological aids. Several studies have demonstrated that computer-assisted surgery (CAS), based on a CT scan, does assist the surgeon in achieving a better and more predictable treatment outcome24,25. CAS consists of several preoperative, intraoperative, and postoperative components. Virtual three-dimensional (3D) diagnostics and preoperative planning software ensures a better inspection of the problem and the possible solutions. The software transforms the CT scan into a 3D reconstruction of the skull. When a patient with an orbital wall fracture is presented, it is possible to measure the volume of both orbital cavities and segment the unaffected side. The unaffected side can then be mirrored and used as a template for the affected side. Virtual surgery is possible by importing STL data of different implants to check for the correct size. When this virtual preoperative plan is compared with a postoperative CT scan of the patient, the accuracy of the treatment can be evaluated26. This is an important learning tool for an inexperienced surgeon. Navigation-guided reconstruction allows for intraoperative guidance and control, to make the orbital reconstruction more accurate and predictable27. Besides intraoperative navigation, intraoperative imaging can be used to evaluate the position of the orbital implant during surgery. A drawback of intraoperative imaging is that it is cumbersome, time-consuming, and exposes the patient to extra ionizing radiation.
Management of orbital wall fractures
The management of orbital wall fractures is at the interface between different specialties, including OMF surgery, ophthalmology, and to a lesser extent plastic surgery and ear, nose, and throat surgery. Over the years, distinct cyclicity in the various treatment strategies can be observed, in which nonsurgical and surgical treatment alternately predominate28. The new technological developments in CAS provide a wide variety of additional supportive treatment options. The ultimate goal of every technological development is enhancing surgical outcome.
General introduction and outline
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