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Virtual Surgical Planning In Pediatric Orbital Reconstruction: Mirroring Technology And Patient Specific Implants On Post-operative Symmetry
Alvin B. Yu, BA, Nicholas A. Han, BSE, David Perrault, MD, Kirin Naidu, MPhil, Santiago Lopez-Becerra, BS, Maura R. Guyler, BA, Jordan W. Swanson, MD, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, CA, USA.
PURPOSE: Virtual surgical planning (VSP) has transformed orbital reconstruction by enabling the creation of mirrored 3D-printed patient-specific implants (PSIs). This study evaluates whether VSP and PSI’s can potentially improve post-operative orbital volume and soft tissue symmetry compared with traditional mesh implants in pediatric patients.
METHODS: A retrospective cohort of 19 pediatric patients who underwent orbital reconstruction for tumor or congenital malformation was analyzed. Pre- and post-operative orbital volumes were measured using Mimics (v.27.0) and orbital shape deviation was analyzed using 3-Matic Medical (v.15.0). Photometric analyses for changes in soft-tissue measurements—including orbital dystopia angle, canthal tilt, pupil width, palpebral height/width, pupil-to-brow distance, and medial/lateral canthal vertical distances—were performed using ImageJ.
RESULTS: Of the 19 patients, seven (36.8%) underwent orbital reconstruction using PSIs. Post-operative volumetric asymmetry decreased significantly following all reconstructions (18.2% vs 8.8%, p=0.006). Improvement in volumetric asymmetry did not significantly differ with use of PSI versus traditional mesh (10.4% vs 8.8%, p=0.966). Similarly, improvements in all soft tissue symmetry metrics did not significantly differ. However, there were significant improvements in orbital shape deviation with use of PSIs (0.74 mm vs -0.05 mm, p=0.013).
CONCLUSION: PSIs achieved comparable improvements in orbital volume and soft tissue symmetry to traditional mesh implants, with significantly improved orbital shape deviation. Our findings support the role of VSP and PSIs as effective, alternative tools for complex pediatric orbital reconstruction.
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