• Oculoplastics/Orbit

    Review of: Patient-specific implants for orbital fractures: A systematic review

    Maher D, Hall A, Gwini S, et al. Ophthalmic Plastic and Reconstructive Surgery, September-October 2022

    A systematic literature review focused on current evidence for patient-specific orbital implants (PSIs) for the purpose of orbital fracture repair.

    Study design

    Fifteen articles published between January 2020 and September 2021 were included, focusing on blowout, naso-orbito-ethmoid, and zygomaticomaxillary orbital fractures. Studies assessed postoperative diplopia, enophthalmos, orbital volume, and complication rates. The PSIs were created via manual molding on a 3D-printed orbital model or a template fabricated from a 3D printer, or directly from a 3D printer.

    Outcomes

    Given the wide range in reported findings in each study, no conclusion could be drawn regarding statistically significant differences between traditional implants and PSIs in terms of the main outcomes. Cost is a major factor, as PSIs ranged from a low of $70 to a high of $7718 USD, with an average of $2644 USD per implant.

    Limitations

    Orbital surgeons understand the varying complexity of the included fracture types. Therefore, focusing on one type of fracture might have been a better option.

    Clinical significance

    Orbital surgeons are encouraged to reserve PSIs for very complex cases or those cases involving patients with faces which have yet to reach full maturity of growth. Given that it takes approximately 5 days to produce a PSI after the design is confirmed, PSIs cannot be considered in urgent cases of orbital fracture repair, such as with tissue entrapment inducing an oculocardiac reflex or threatening muscle ischemia.