Restoration of the inferomedial orbital strut using a standardized three‐dimensional printing implant

• Published in: Journal of anatomy Vol. 236; no. 5; pp. 923 - 930
• Main Authors: Kim, Jun Hyeok, Lee, In‐Gyu, Lee, Jeong‐Seok, Oh, Deuk Young, Jun, Young Joon, Rhie, Jong Won, Shim, Jin‐Hyung, Moon, Suk‐Ho
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2020; John Wiley and Sons Inc
• Subjects: 3D printed implants; Adult; Anatomy; Cadavers; Computed tomography; Computer Simulation; computer‐aided design; Female; Humans; inferomedial orbital strut; Male; Middle Aged; Orbit - diagnostic imaging; Orbit - surgery; orbital fracture; Orbital Fractures - diagnostic imaging; Orbital Fractures - surgery; Original; Original Paper; Polycaprolactone; Printing, Three-Dimensional; Prostheses and Implants; Statistical analysis; Tomography, X-Ray Computed; Transplants & implants; Treatment Outcome; inferomedial orbital strut; computer-aided design; orbital fracture; 3D printed implants
• ISSN: 0021-8782; 1469-7580
• DOI: 10.1111/joa.13136

The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three‐dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer‐aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre), and Vpost compared with Vpre also showed a statistically significant difference (P < 0.05). On follow‐up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients. The aim of this study was to incorporate data from cadaveric orbit anatomy into three‐dimensional (3D) printing technology, and to elaborately reconstruct the complex orbital fracture. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model and the patients.