CLINICAL AND RADIOGRAPHIC EVALUATION OF THREE-DIMENSIONAL PRE-BENT ORBITAL PLATES IN MANAGEMENT OF ORBITAL FRACTURES. RANDOMIZED CONTROLLED TRIAL

Background:Orbital fractures are commonly seen in maxillofacial practice. Recently, three-dimensionally preformed orbital implants have been introduced to enhance the accuracy of reconstruction in complex defects of the orbital floor and medial wall. These implants are designed based on consistent orbital shapes and common fracture patterns, enabling reliable restoration of the orbital contour. This study aims to evaluate and compare, through clinical and radiographic assessments, the reconstructive outcomes achieved with standard preformed titanium orbital meshes versus three-dimensionally anatomical orbital plates in post-traumatic internal orbital defects. 

Materials and Methods:This clinical study included eighteen randomly selected patients, nine in each group, who were amenable to internal orbital reconstruction. All patients enrolled in this study underwent clinical and radiographic examinations, including preoperative CT scans and immediate postoperative CT scans, and preoperative stereolithographic three-dimensional mirrored-printed orbital models for patients in the group treated with standard preformed implants. Additionally, surgical procedures were performed via transcutaneous or transorbital routes. All patients underwent radiographic follow-up one day postoperatively and had three clinical follow-up visits at one week, four weeks, and twelve weeks. Orbital volume, corneal projection, motility restriction, visual acuity, diplopia, and implant contour analysis were used as calipers to evaluate the accuracy of orbital reconstruction. 

Results: Using 3D titanium orbital plates in reconstructive surgery for orbital wall fractures resulted in significantly more accurate restoration of orbital volume than conventional titanium mesh (p = 0.04). It also showed a stronger inverse correlation with Hertel exophthalmometry (r = −0.60, p = 0.048) and significantly reduced operative time (p <0.001). 

Conclusion: 3D titanium orbital plates provide a more accurate and straightforward method for repairing orbital floor and medial wall fractures, minimizing surgical time, enabling more precise anatomical reconstruction, and allowing for quicker surgeries.