BACKGROUND: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy.
OBJECTIVE: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers (\"In-House\" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh.
METHODS: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data.
RESULTS: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the \"Magna Graecia\" University Hospital of Catanzaro 10 fulfilled the study\'s inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment.
CONCLUSIONS: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient\'s anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

OBJECTIVE: The aim of this study was to analyse the outcomes of orbital floor reconstruction with two types of orbital implants and assess patients\' quality of life.
METHODS: 39 sequential patients with clinical and radiological evidence of orbital floor fracture, presenting diplopia, enophthalmos, paraesthesia or a post traumatic residual orbital deformity were included in this study and randomised for orbital floor reconstruction using porous polyethylene sheet (Biopore™) or preshaped titanium mesh on a 3D model. Their pre and postoperative quality of life were compared. Success rate was assessed and scored with a minimum of zero (none) and a maximum of ten (excellent) for improvement in the signs of diplopia, enophthalmos, hypoglobus, paraesthesia and aesthetics.
RESULTS: Both QOL scores and Success score was greater in cases which reconstruction of orbital floor was performed with preshaped titanium mesh as compared to those with Biopore™.
CONCLUSIONS: Preshaped titanium mesh shows better results than reconstruction with Biopore™. However a large sample size and a long term follow up is needed for generating the best evidence. Quality of life extensively improves after orbital floor reconstruction motivating the patients desire to live.

In this prospective study we evaluated the duration of insertion and the accuracy of fitting of computer-aided design (CAD)-based pre-bent orbital floor plates compared with non-preformed orbital plates in reconstruction of the orbital floor. Thirty-six patients with unilateral fractures of the orbital floor were included; pre-bent plates were used in 25 and non-preformed plates in 11. Preoperative computed tomography (CT) scans were used for CAD of individualised implants. The anatomy of the affected orbit was virtually reconstructed \"slice by slice\". Individually pre-bent plates were generated using a stereolithographic model of the reconstructed orbit. The mean (SD) duration of insertion was significantly reduced when pre-bent orbital plates were used (5.5 (5.4) min) compared with non-preformed meshes (11.1 (7.7) min). The congruence of pre-bent plates to the infraorbital rim did not differ from that of non-preformed plates. The accuracy of fit was rated as \"accurate\" in 24 cases. CAD-based individualised titanium meshes reduce theatre time compared with non-preformed orbital plates. Our results confirm the efficacy of CAD-based pre-bent plates in reconstruction of the orbital floor.

Dissection on to the facial aspect of the zygoma is common in procedures of the midface for trauma, craniofacial deformity, and cosmesis. These procedures carry the risk of injury to the neurovascular structures that exit from the zygomaticofacial foramen (ZFF). The purpose of this study was to map the ZFF, and to establish reliable reference points from which to identify it before and during operation. We also aimed to compare the anatomy of the ZFF between sexes and among geographical populations. A total of 429 adult skulls from nine geographical sites were used. A cross-line laser was superimposed on to each zygoma to generate consistent landmarks (lines 1 and 2) from which to measure the ZFF, and the number of ZFF on each zygoma was recorded. The site and incidence of ZFF differed significantly among geographical populations, but not between sexes. Of all 858 sides, no foramina were found in 16.3%, one foramen in 49.8%, two foramina in 29%, three in 3.4% and four in 1.4%. A total of 93% of foramina were within a 25mm diameter zone (ZFF zone) centred 5mm anterior to the intersection of lines 1 and 2 on the right zygoma, and 94% were within equivalent measurements on the left. Using these landmarks, we propose a new method of identifying a ZFF zone that is irrespective of sex or geographical population. This technique may be useful in the prevention of iatrogenic damage to the ZFF neurovascular bundle during procedures on the midface and in local nerve blocks.

The orbital floor is the thinnest part of the orbital wall, and in 20% of all maxillofacial injuries it is fractured. Autografts, allografts, and alloplastic materials are used in reconstruction, but there is no consensus about which material is the most appropriate. Nail is a semirigid material that is easy to reshape and is not antigenic. Alloplastic materials, which are used in reconstructions of the orbital floor, have various complications and are expensive. Autografts have donor-site problems, high rates of resorption, and take a long time to do. We created bilateral 10mm defects in the orbital floors in 18 New Zealand rabbits. We reconstructed the left orbital floors with double-ground human nail while the right orbital floors were left open as controls. The orbital floors were examined macroscopically and microscopically at 4, 8, and 12 weeks postoperatively, and there were no macroscopic signs of infection, inflammation, or extrusion. Forced duction tests showed that it was possible to induce movement of the eyeball for all 18 of the reconstructed sides throughout the observation period, and in 14 of the 18 rabbits on the control sides. Positive forced duction test shows us that orbital muscles are trapped in orbital floor defect and due to this movement of eyeball is restricted. Acute and chronic inflammation, fibrosis, vascularisation, and the presence of foreign body giant cells were evaluated microscopically. Acute inflammation and the presence of foreign body giant cells were recorded as mild, whereas fibrosis, chronic inflammation, and vascularisation were severe, as were epithelialisation on the maxillary sinus side of the nails, calcification, and progression of collagen. We found no signs of resorption of the nails.

OBJECTIVE: The aim of the present study was to assess the utility of anterolateral wall of maxilla as a bone graft to reconstruct the continuity of orbital floor.
METHODS: This study was carried out at Datarkar Institute of Maxillofacial Surgery, Pratap Nagar, Nagpur. Out of five patients selected, three were male and two were female. All the patients had intact anterolateral wall of maxilla on contralateral side. In all the patients the reduction of the zygomatic complex fracture was done by Keen\'s approach. The fractures were stabilized by miniplates. From the contralateral sides,bone graft of 1.5 × 2 cm size was harvested from which were intact in all the patients. All the patients were reviewed at regular interval, initially once every week for 1 month, followed by once in every month for next 6 months postoperatively.
RESULTS: Five patients with orbital floor defects of medium size average 1.16 cm size (range 0.8-1.5 cm) were grafted by using autogenous bone graft harvested from anterolateral wall of maxilla. All the patients were successfully reconstructed with restoration of the orbital wall continuity. We have not come across any complications like infection, exposure, and extrusion of the graft. Only one patient did not show much improvement in enopthalmous where the size of the defect was large.
CONCLUSIONS: The use of harvested bone graft from the anterolateral wall of the maxilla is better option for the reconstruction of orbital floor defects.

OBJECTIVE: The present study aimed to evaluate and analyze postoperative results of Autogenous Mandibular Symphysis graft material for orbital floor reconstruction.
METHODS: A retrospective study was conducted on 11 patients, having an isolated blow out fracture (n=4) or orbital floor defects associated with other fractures (n=7). These fractures were reconstructed with Mandibular symphysis bone grafts. The Grafts were used where the defects were more than 1.5 centimeter [1]in diameter. Follow up as long as 1.5 year was kept. Patients were evaluated at recall visits by checking various extraoccular movements. Evidence of any complications like diplopia or enopthalmos, or rejection of graft or any symptoms of infection, or of paresthesia was recorded.
RESULTS: During a 1.5 year period of follow up, most of the patients had no postoperative complaints. There was good restoration of the orbital floor, with no clinical evidence of enopthalmos or diplopia. Extraoccular movements were intact in all patients. Only one patient presented with the symptoms of infection at a follow up period of 9 months. The infection subsided after removal of titanium plates, used for the stabilization of graft.
CONCLUSIONS: Autogenous Mandibular Symphysis graft is a good alternative with minimal morbidity for orbital floor reconstruction. The contour as well as the size of the graft available from symphysis region best suits for orbital floor reconstruction.