Digital Technologies in the Surgical Treatment of Post-Traumatic Zygomatico-Orbital Deformities

The aim of the study was to determine the efficacy of using digital technologies in patients with post-traumatic deformities of the zygomatico-orbital complex (ZOC) by comparing the results with the conventional methods of surgical treatment.

Materials and Methods. The article summarizes treatment results of 231 patients with ZOC injuries who underwent surgery at the clinical facilities of Privolzhsky Research Medical University (Nizhny Novgorod) in 2011–2019. There were treated 44.2% (102/231) of patients with post-traumatic deformities of ZOC, including 38.2% (39/102) with post-traumatic defects and deformities of the orbital floor.

Based on clinical and radiological planning of surgical operations, the patients were divided into two groups: group 1 included patients who underwent surgery without preoperative virtual planning (54.9% (56/102) of cases), group 2 included patients who underwent virtually planned surgical interventions (45.1% (46/102) of cases). There were 22 and 17 patients with orbital deformities in groups 1 and 2, respectively.

Results. The optimal restoration of ZOC anatomy was observed in 75% (42/56) of patients in group 1 and 93.5% (43/46) of patients in group 2. During reconstruction of the orbital floor in patients of group 1, successful results were achieved in 68.2% (15/22) of cases and 88.2% (15/17) in group 2, various complications were observed in the rest of cases.

Based on the analysis of surgical treatment results, there was developed a personalized approach to manufacturing of zygomatic bone and orbital floor implants using computer modeling and 3D printing technologies.

Conclusion. In contrast to the conventional methods, the use of digital technologies in the surgical treatment of post-traumatic deformities of ZOC allows avoiding the problematic issues of implant positioning and the development of complications during reconstruction, significantly reducing surgical injury and improving patient rehabilitation.

1. Gundorova R.A., Neroev V.V., Kashnikova V.V. Travmy glaza [Eye injuries]. Moscow: GEOTAR-Media; 2009.
2. Durnovo E.A., Khomutinnikova N.E., Mishina N.V., Trofimov A.O. The peculiarities of the reconstruction of the walls of orbital cavity during the treatment of traumatic damages of facial skeleton. Medicinskij al’manah 2013; 5(29): 159–161.
3. Nikolaenko V.P., Astakhov Yu.S. Orbital’nye perelomy [Orbital fractures]. Saint Petersburg: Eko-vektor; 2012; 436 p.
4. Scolozzi P., Jacquier P., Courvoisier D.S. Can clinical findings predict orbital fractures and treatment decisions in patients with orbital trauma? Derivation of a simple clinical model. J Craniofac Surg 2017; 28(7): e661–e667, https://doi.org/10.1097/scs.0000000000003823.
5. Ko M.J., Morris C.K., Kim J.W., Lad S.P., Arrigo R.T., Lad E.M. Orbital fractures: national inpatient trends and complications. Ophthalmic Plast Reconstr Surg 2013; 29(4): 298–303, https://doi.org/10.1097/IOP.0b013e318295f91d.
6. Grusha Ia.O. Modern aspects of reconstructive surgery for orbital trauma. Vestnik oftal’mologii 2014; 130(6): 50–55.
7. Lutsevich E.E., Al’khumidi K. Modern aspects of diagnostics and treatment of orbital fractures. Vestnik oftal’mologii 2013; 129(6): 89–95.
8. Strong E.B. Orbital fractures: pathophysiology and implant materials for orbital reconstruction. Facial Plast Surg 2014; 30(5): 509–517, https://doi.org/10.1055/s-0034-1394099.
9. Bakushev A.P., Sivolapov K.A. Surgical treatment of patients with isolated fractures of orbit walls. Oftal’mologiya 2015; 12(3): 48–52.
10. Eolchiyan C.A., Kataev M.G., Karnaukhova A.V. Elimination of functional and aesthetic disorders in the surgical treatment of post-traumatic defects and deformations of the orbit and periorbital region. Esteticheskaya meditsina 2012; 11(4): 543–554.
11. Mitroshenkov P.N. Comparative assessment of the efficiency of plastic correction of total and subtotal defects in the upper and mid-facial zones using perforated titanium plates and bone autografts. Annaly plasticheskoj, esteticheskoj i rekonstruktivnoj hirurgii 2007; 4: 32–45.
12. Khomutinnikova N.E., Durnovo E.A., Mishina N.V., Vyseltzeva Yu.V. Short- and long-term results of orbital floor fractures treatment. Stomatologiya 2018; 97(5): 54–58, https://doi.org/10.17116/stomat20189705154.
13. Clauser L., Galiè M., Pagliaro F., Tieghi R. Posttraumatic enophthalmos: etiology, principles of reconstruction, and correction. J Craniofac Surg 2008; 19(2): 351–359, https://doi.org/10.1097/SCS.0b013e3180534361.
14. Grusha O.V., Grusha Ia.O. Five hundred orbital plastic repairs: analysis of complications. Vestnik oftal’mologii 2006; 122(1): 22–24.
15. Lezhnev D.A., Davydov D.V., Kostenko D.I. Capabilities of current tomographic technologies in the diagnosis of midfacial injuries and posttraumatic deformities. Vestnik rentgenologii i radiologii 2013; 5: 005-008.
16. Seleznev V.A., Butsan S.B., Jigitaliyev Sh.N., Khokhlachev S.B., Hodyachiy A.E., Chernenkiy M.M. Virtual planning of orbital bone reconstruction surgery. Rossiyskiy elektronnyy zhurnal luchevoy diagnostiki 2018; 8(3): 128–148.
17. Karyakin N.N., Gorbatov R.O. 3D-pechat’ v meditsine [3D printing in medicine]. Moscow: GEOTAR-Media; 2019; 240 p., https://doi.org/10.33029/9704-5163-2-PRI-2019-1-240.
18. Khassan M.A., Khovrin A.A., Mitroshenkov P.N., Kantemirov O.I., Scherbovskikh A.E. 3-dimensional modelling of facial scull radiological image in reconstructive surgery of facial deformities. Head and Neck 2017; 1: 13–17.

Khomutinnikova N.E., Durnovo E.A., Vyseltseva Yu.V., Gorbatov R.O. Digital Technologies in the Surgical Treatment of Post-Traumatic Zygomatico-Orbital Deformities. Sovremennye tehnologii v medicine 2020; 12(3): 55, https://doi.org/10.17691/stm2020.12.3.07