Customized Orbital Wall Reconstruction Using Three-Dimensionally Printed Rapid Prototype Model in Patients With Orbital Wall Fracture

Background: It is difficult to restore original orbital contours because of their complex 3-dimensional structure. Moreover, slight implant malpositioning can result in enophthalmos or other complications. The authors describe our experience of using individualized prebent titanium-Medpor mesh implants and stereolithographic modeling in a series of patients who underwent orbital wall reconstruction. Methods: A consecutive series of 104 patients with orbital fractures received computer simulation-designed prebent titanium-Medpor mesh implants insertion. Preoperative computed tomography (CT) data were processed for each patient, and a rapid prototyping (RP) model was produced. The uninjured side was concurrently mirrored and superimposed onto the traumatized side to create a mirror image of the RP model. The authors fabricated the titanium-Medpor implants to intraoperatively reconstruct the 3-dimensional orbital structure. The prefabricated titanium-Medpor implants were inserted into the defective orbital wall and fixed. Postoperative CT images were immediately taken to evaluate the reconstructed contours and compare the preoperative and postoperative intraorbital volumes. Results: All reconstructions were successful without postoperative complications. The implants were correctly positioned in the sagittal, axial, and coronal planes relative to the original orbital contours. The mean preoperative intraorbital volumes of the uninjured and traumatized sides were 21.39 ± 1.93 and 23.17 ± 2.00 cm3, respectively, and the postoperative mean intraorbital volume was 20.74 ± 2.07 cm3. Conclusions: Orbital reconstruction can be optimized using individually manufactured rapid prototype skull model and premolded synthetic scaffold by computer-aid of mirroring-reconstruction of 3-dimensional images and 3-dimensional printing techniques.