DOI QR코드

DOI QR Code

Application of 3D Simulation Surgery to Orbital Wall Fracture : A preliminary Case Study

  • Choi, Jong-Woo (Department of Plastic and Reconstructive Surgery, College of Medicine, Ulsan University, Seoul Asan Medical Center)
  • Received : 2014.07.08
  • Accepted : 2014.07.15
  • Published : 2014.07.19

Abstract

The orbit has a very special anatomical structure. The complex anatomical structure should be restored when we encounter the patient with orbital wall fracture. Unless these specific anatomy were reconstructed well, the patient should suffer from various complications such enophthalmos, diplopia or orbital deformity. In addition, because the patient has a his own specific orbital shape, individualized approach will be necessary. The aim of this trial is to try to restore the original orbit anatomy as possible based on the mirrored three dimensional CT images based on the computer simulation. Preoperative computed tomography (CT) data were processed for the patient and a rapid prototyping (RP) model was produced. At the same time, the uninjured side was mirrored and superimposed onto the traumatized side, to create a mirror-image of the RP model. In order to restore the missing skipped images between the cuts of CT data because of the thinness of the orbital walls, we manipulated the DICOM data for imaging the original orbital contour using the preoperatively manufactured mirror-image of the RP model. And we fabricated Titanium-Medpor to reconstruct three-dimensional orbital structure intraoperatively. This prefabricated Titanium-Medpor was then inserted onto the defected orbital wall and fixed. Three dimensional approach based on the computer simulation turned out to be very successful in this patient. Individualized approach for each patient could be an ideal way to manage the traumatic patients in near future.

Keywords

References

  1. Kakizaki H, Takahashi Y, Asamoto K, Nakano T, Selva D, Leibovitch I. Anatomy of the superior border of the lateral orbital wall: surgical implications in deep lateral orbital wall decompression surgery. Ophthalmic plastic and reconstructive surgery. 2011 Jan-Feb;27(1):60-3. PubMed PMID: 20736872 https://doi.org/10.1097/IOP.0b013e3181dfce2f
  2. Beden U, Edizer M, Elmali M, Icten N, Gungor I, Sullu Y, et al. Surgical anatomy of the deep lateral orbital wall. European journal of ophthalmology. 2007 May-Jun;17(3):281-6. PubMed PMID: 17534804
  3. Oh SA, Aum JH, Kang DH, Gu JH. Change of the orbital volume ratio in pure blow-out fractures depending on fracture location. The Journal of craniofacial surgery. 2013 Jul;24(4):1083-7. PubMed PMID: 23851745 https://doi.org/10.1097/SCS.0b013e31828b6c2d
  4. Lee H, Ahn J, Lee TE, Lee JM, Shin H, Chi M, et al. Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration. The Journal of craniofacial surgery. 2012 Sep;23(5):1399-403. PubMed PMID: 22948636 https://doi.org/10.1097/SCS.0b013e31825ab043
  5. Lee S, Yen MT. White-eyed blow-out fracture. Journal of pediatric ophthalmology and strabismus. 2011 Sep-Oct;48(5):320. PubMed PMID: 21913629 https://doi.org/10.3928/01913913-20110722-02
  6. Park JS, Lew H, Lee SY. Role of inferior orbital wall morphologic properties in isolated orbital blow-out fracture. Ophthalmic research. 2012;47(1):1-6. PubMed PMID: 21691135 https://doi.org/10.1159/000326894
  7. Hayakawa I. [Surgical treatment of the orbital blow-out fracture (author's transl)]. No shinkei geka Neurological surgery. 1976 Oct;4(10):933-40. PubMed PMID: 1033468
  8. Kugelberg U. Diplopia in down-gaze after a blow-out fracture. Acta ophthalmologica Scandinavica. 1998 Oct;76(5):629-31. PubMed PMID: 9826057 https://doi.org/10.1034/j.1600-0420.1998.760527.x