Prof. Takahiro Kanno, DDS, FIBCSOMS, FIBCSOMS-ONC/RECON, PhD
Department of Oral and Maxillofacial Surgery, Shimane University
Faculty of Medicine & Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
Orbital trauma and fractures with orbital wall defects are common facial fractures encountered by us, oral–maxillofacial surgeons, because of the exposed position and thin bony walls of the midface. The primary goal of surgery is to restore the pre-injury 3-D (dimensional) anatomy and volume of hard tissue and to free incarcerated or prolapsed orbital tissue from the fracture by bridging the bony defects with reconstructive implant material and restoring the maxillofacial–orbital skeleton. Numerous studies have reported orbital fracture repair with a wide variety of implant materials, such as autogenous bone and artificial materials, that offer various advantages and disadvantages. The ideal orbital implant material will allow conformation to individual patients’ anatomical characteristics, remain stable over time, and be radiopaque, especially for the reconstruction of relatively large and/or complex bony walls.
Recent innovations, such as computer-assisted surgical planning and intraoperative navigation, could improve the efficacy, precision, and predictability of surgical treatments of such orbital trauma reconstruction. Multi-planar CT scans, associated with 3-D reconstruction software, show variability in anatomy among individuals and help the surgeon identify a specific bone area to resect or reconstruct. The reconstruction abilities of the software could also be used to virtually display the patient's anatomy throughout the case, allowing for stereotactic navigation. Further, computerized navigation involves a virtual interface between the intraoperative position of the surgical instruments and the reconstruction of patient anatomy, which is performed using CT scans. During the surgery, the navigation system controls the position of the implants or the mobilized bone and verifies the final location. Intraoperative navigation enhances the surgeon’s ability to measure the extent of resection, identify important anatomical landmarks, and confirm the orientation of bone grafts. Using this approach, it is possible to reduce human error, promoting greater adherence to the preoperative plan. Furthermore, intraoperative navigation could reduce the incidence of postsurgical complications due to incorrect positioning or orientation of bone grafts, plates, or fixation screws, especially for relatively large orbital wall(s) boney defects as type 3 to 4 cases.
Furthermore, I would like to discuss with you on our Japanese innovative biomaterial, u-HA/PLLA composite sheet for orbital trauma reconstruction because of their bioactive, osteoconductive, and bioresorbable properties. Other orbital trauma bone graft materials for reconstruction as parietal bone from calvaria and anterior maxillary sinus wall, will be further discussed in terms of Pros & Cons.
I am greatly honored and happy to share with you, Taiwanese and Oral-Maxillofacial Surgeons from overseas through this fruitful international Takao-Forum 2022 in Kaohsiung, Taiwan.
