背景:眼睛是面部的中心美学单元。颌面部创伤可改变面部比例,影响视功能,严重程度不同。传统的重建方法有许多局限性,使这个过程具有挑战性。这项研究的主要目的是评估三维(3D)导航在复杂的单侧轨道重建中的应用。
方法:一项前瞻性队列研究进行了19个月(2020年1月至2021年7月),连续纳入12例符合纳入标准的患者.每个患者随访至少6个月。主要研究者对几个因素进行了比较分析,包括断裂形态,轨道体积,地球投影,复视,面部形态变化,盖子缩回,和眶下神经感觉减退.
结果:有9例眼眶骨折,而其余的则是纯粹的骨折.正常侧的中位轨道体积(30.12cm3;四分位距[IQR],28.45-30.64)与重建轨道(29.67cm3;IQR,27.92-31.52)。复视显著改善(T(10)=2.667,p=0.02),尽管全球预测没有统计学上的显着改善。实现了面部标志的总体对称,面部宽高比和睑裂长度相当。两名患者在就诊时报告了眶下感觉减退,在6个月的随访中持续存在。此外,5例患者出现下眼睑回缩(1-2mm),一个人在眶下边界经历了植入物撞击。
结论:我们的研究提供了支持使用3D导航来改善复杂眼眶重建手术结果的II级证据。
BACKGROUND: The eyes are the central aesthetic unit of the face. Maxillofacial trauma can alter facial proportions and affect visual function with varying degrees of severity. Conventional approaches to reconstruction have numerous limitations, making the process challenging. The primary objective of this study was to evaluate the application of three-dimensional (3D) navigation in complex unilateral orbital reconstruction.
METHODS: A prospective cohort study was conducted over 19 months (January 2020 to July 2021), with consecutive enrollment of 12 patients who met the inclusion criteria. Each patient was followed for a minimum period of 6 months. The principal investigator carried out a comparative analysis of several factors, including fracture morphology, orbital volume, globe projection, diplopia, facial morphic changes, lid retraction, and infraorbital nerve hypoesthesia.
RESULTS: Nine patients had impure orbital fractures, while the remainder had pure fractures. The median orbital volume on the normal side (30.12 cm3; interquartile range [IQR], 28.45-30.64) was comparable to that of the reconstructed orbit (29.67 cm3; IQR, 27.92-31.52). Diplopia improved significantly (T(10) = 2.667, p = 0.02), although there was no statistically significant improvement in globe projection. Gross symmetry of facial landmarks was achieved, with comparable facial width-to-height ratio and palpebral fissure lengths. Two patients reported infraorbital hypoesthesia at presentation, which persisted at the 6-month follow-up. Additionally, five patients developed lower lid retraction (1-2 mm), and one experienced implant impingement at the infraorbital border.
CONCLUSIONS: Our study provides level II evidence supporting the use of 3D navigation to improve surgical outcomes in complex orbital reconstruction.