Case Report 10

(Major Orbital Injury)


(Pre operation)

 

(Customised Orbital Floor)
(no cranial bone graft required)


6 weeks






Case Summary

1. Implant stable @ 24 months (January 2001)

2. No major surgery required.

3. No second donor surgical site required to effect primary reconstruction.

4. Precise and superior replication of the anatomy of the orbital floor and rim.

5. Surgery time - 30 minutes.

6. No Intensive care required.

7. Enhanced rehabilitation.

8. Reduction in morbidity - no bone grafting required.

9. Significant Cost Savings for Purchasers of Health Care.



Comment

Digital images of the biomodel and facial aesthetics were manipulated using a technique called photomorphanalysis. This was very useful in the clinical audit of this case, and demonstration of outcome. The cosmetic result even at 6 weeks is excellent.

This technique permitted great precision in the correction of a difficult orbital deformity with minimal access techniques, without recourse to bone grafting techniques which produce inferior replication of orbital contour, and without the need for major surgery. The excellent outcome eliminated enophthalmos (the sinking backwards movement of the eye, and poor aesthetics that occurs when the correct orbital volume is not replicated); and it is advocated that orbital volume is the prime cause of enophthalmos rather than loss of periorbital fat, as has been suggested elsewhere. It is to be noted that the implant could only be seated correctly after the more stripping of tissues from the orbital floor, than might be expected.

It is the author's view that such stripping of tissues, if not thorough, may lead to the placement of alternative implants or bone grafts that are too small to replicate the correct orbital volume, and that this may be the true cause of post operative enophthalmos. The use of stereoscopic biomodel planning and a customised implant ensures that the optimum contour of the orbit is replicated and that adequate stripping of tissue from the orbital floor has to be undertaken in order to fit the implant. It is therefore not surprising that enophthalmos has been prevented.

This patient has no diplopia (double vision) following this procedure.





Mpg file 469KB please wait - file below downloading.......





Patient Comment @ 2 years (please hover over image for verbal comment)