Page 44 - Advanced concepts in orbital wall fractures

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Chapter 2
subtraction of bone and air density masks) can be highly recommended based on the results of the study. This method proved to be accurate, reproducible, quick, and easy to use. The automatic segmentation option should only be used in combination with educated inspection afterward. This is mainly because of errors due to automatically adding volume of bony and pneumatised areas, as well as added volume of the inferior orbital fissure.
The accuracy of orbital reconstructive surgery will benefit from improvements in diagnostics and planning using three-dimensional (3D) software. Apart from experience and surgical skills, outcomes of orbital reconstruction depend on careful and precise measurements and planning in the preoperative assessment, intraoperative navigation, and intraoperative radiography. Method SA could provide better preoperative assessment and might therefore result in fewer complications and less need for secondary reconstructions.
The researchers are aware that many additional aspects, such as posttraumatic and iatrogenic fat atrophy, fibrosis, and adhesions may affect the outcome of orbital surgery. It is believed to be possible to exactly restore the volume of the bony orbit, but changes in the orbital content may compromise the final result. Nevertheless, the extent of these factors is difficult to analyse without adequate orbital volume measurements. In preoperative assessment, correct and accurate orbital volume calculation should be part of diagnosing orbital pathology and (virtual 3D) planning of orbital reconstructions. A next challenge is volume segmentation in patients with an orbital fracture. Future steps may be segmentation and manipulation, e.g. implementation of mirroring of the unaffected contralateral orbit. Further studies are being performed to validate the benefits of these new methods.