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Neuroimaging Clin N Am ; 32(1): 193-202, 2022 Feb.
Article En | MEDLINE | ID: mdl-34809839

There is a plethora of surgical procedures that are performed in the eye and orbit. The consequences of these procedures can often be observed on diagnostic imaging through the presence of various implants and altered anatomy. The expected postoperative changes in the eye and orbit, the impact of implants on image quality and safety, and potential associated complications are reviewed in this article. Conventional computed tomography and MR imaging scans are useful for the postoperative assessment of the eye and orbit. The computed tomography and MR imaging findings related to the postoperative eye and orbit are reviewed in this article.

Magnetic Resonance Imaging , Orbit , Diagnostic Tests, Routine , Humans , Orbit/diagnostic imaging , Orbit/surgery , Tomography, X-Ray Computed , Vision Disorders
Vestn Oftalmol ; 137(5): 47-51, 2021.
Article Ru | MEDLINE | ID: mdl-34726857

PURPOSE: To evaluate the role of tarsorrhaphy and its effectiveness in the treatment of patients with thyroid eye disease (TED). MATERIAL AND METHODS: The study identified the patients who required tarsorrhaphy for corneal lesions associated with TED among the total number of 457 patients who underwent tarsorrhaphy at the Research Institute of Eye Diseases over the past 20 years. RESULTS: Overall, 477 tarsorrhaphy surgeries (457 patients) were performed, including temporary and permanent, partial and complete. The corneal involvement in TED was the indication for tarsorrhaphy in 81 patients (101 tarsorrhaphies). TED patients were divided depending on the date of operation, and it was found that 61 tarsorrhaphies were performed in the period from 2000 to 2009, and 40 similar interventions were performed in the period from 2010 to 2019. CONCLUSION: The reduction in the number of tarsorrhaphy surgeries in patients with TED in the last decade due to improvement of techniques for bony decompression of the orbit and increase in the number of these operations allowed significant reduction of the degree of proptosis and, as a consequence, the exposure surface area of the eye. However, despite all the successes achieved in orbital surgery, tarsorrhaphy still remains an affordable technique that can always be used in case of corneal lesions in thyroid eye disease.

Graves Ophthalmopathy , Decompression, Surgical , Eyelids/surgery , Graves Ophthalmopathy/diagnosis , Graves Ophthalmopathy/surgery , Humans , Ophthalmologic Surgical Procedures , Orbit/surgery , Retrospective Studies
J Binocul Vis Ocul Motil ; 71(4): 127-131, 2021.
Article En | MEDLINE | ID: mdl-34752185

In a review of 261 strabismus surgeries performed after previous orbital surgery, it was found that diplopia associated with orbital surgery most commonly occurs after orbital decompression for thyroid eye disease or after repair of orbital fractures. Other types of orbital surgery account for only a small number of cases. While the orbital surgery itself may contribute to the development or worsening of diplopia, in most cases, the post-operative strabismus is largely attributable to the underlying disease or trauma. However, in a small number of cases, a specific surgical misadventure can result in diplopia.

Decompression, Surgical , Diplopia , Diplopia/etiology , Humans , Ophthalmologic Surgical Procedures/adverse effects , Orbit/surgery , Retrospective Studies
Ugeskr Laeger ; 183(39)2021 09 27.
Article Da | MEDLINE | ID: mdl-34596514

Orbital compartment syndrome is an uncommon complication of trauma to the eye and its surroundings or a rare complication to sinus surgery. Nevertheless, it is important to diagnose and treat the condition urgently as it may cause irreversible visual impairment. In this case report, we describe a 29-year-old male suffering from a blunt trauma to the eye. He developed exophthalmus and visual impairment. A blow-out fracture and haematoma in the orbital compartment was diagnosed. Successful bedside urgent lateral canthotomy and cantholysis was performed followed by semi-urgent osteosynthesis of the fracture. The patient recovered without visual impairment.

Compartment Syndromes , Wounds, Nonpenetrating , Adult , Compartment Syndromes/diagnosis , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Eyelids , Hematoma/diagnostic imaging , Hematoma/etiology , Hematoma/surgery , Humans , Male , Orbit/diagnostic imaging , Orbit/injuries , Orbit/surgery , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/surgery
BMJ Case Rep ; 14(10)2021 Oct 13.
Article En | MEDLINE | ID: mdl-34645635

Orbital trauma is commonly complicated by retention of intraorbital foreign bodies. A 39-year-old man presented following a penetrating injury to the right orbit, with CT evidence of foreign bodies in the right anterior and posterior medial orbit. The foreign bodies were found to be a mixed composition of metal and wood. Characterising wood on CT imaging is difficult due to its radiolucency and low density, which can be mistaken for air in the setting of traumatic orbital emphysema. Increasing the window width on bone window settings can be used to distinguish wood from air, which is crucial for facilitating its complete surgical removal.

Eye Foreign Bodies , Eye Injuries, Penetrating , Orbital Diseases , Adult , Eye Foreign Bodies/diagnostic imaging , Eye Foreign Bodies/surgery , Eye Injuries, Penetrating/diagnostic imaging , Eye Injuries, Penetrating/surgery , Humans , Orbit/diagnostic imaging , Orbit/injuries , Orbit/surgery , Tomography, X-Ray Computed , Wood
J Craniofac Surg ; 32(7): 2546-2550, 2021 Oct 01.
Article En | MEDLINE | ID: mdl-34705364

ABSTRACT: The authors investigated orbital bone development in congenital microphthalmia (CM) using a three-dimensional finite element analysis model, after the orbital dimension deficiency was improved with a self-inflating hydrogel expander implant.Data of a 2-year-old male CM patient were examined. The orbital structure, eyeball, eye muscles, and self-inflating hydrogel expander were constructed according to computed tomography examination data. The effects of self-expanding spherical hydrogel at various locations in the muscle cone on orbital bone development were examined using 3-mL self-expanding expanders placed at shallow (model 1: 2 mm depth) and deep (model 2: 8 mm depth) muscle cone positions. This model simulated the hydrogel expansion process; the orbital bone biomechanics and radial displacement nephograms were obtained when the hydrogel volume increased 3, 5, 7, and 9 times and analyzed.The orbital bone biomechanics were concentrated at the medial orbital wall center, gradually spreading to the whole orbital wall. Biomechanics and radial displacement of the inferior temporal and lateral distal orbital wall region were the most significant, and were more significant in model 1 than in model 2.Finite element analysis is suitable for the biomechanical analysis of orbital development in CM. The shallow position inside CM patients' muscle cone is the optimal site for hydrogel implantation.

Hydrogel, Polyethylene Glycol Dimethacrylate , Microphthalmos , Biomechanical Phenomena , Child, Preschool , Finite Element Analysis , Humans , Male , Orbit/diagnostic imaging , Orbit/surgery , Tissue Expansion Devices
J Craniofac Surg ; 32(7): 2465-2467, 2021 Oct 01.
Article En | MEDLINE | ID: mdl-34705389

ABSTRACT: Three-dimensional (3D) modeling and printing technologies are increasingly utilized as tools to assist in complex craniofacial reconstructions. Herein, the authors report the intraoperative use of sterilized 3D models printed in-house to mold a custom resorbable implant in the case of a pediatric patient with a unilateral complex orbital fracture. The imaging was processed with open-source software. Two patient-specific orbital models were 3D-printed (Fig. 2): a life-size print of the patient's preoperative CT scan and a left orbit reconstructed to resemble its uninjured state using mirrored-imaging of the uninjured side. This construct ultimately served as a sterilized template to mold a resorbable implant intraoperatively. Post-operatively, the patient experienced no complications. At the 18-month follow-up, the patient had done well without diplopia, headaches or visual problems. The authors report a case of a successful orbit reconstruction assisted by mirrored-image computer modeling and patient-specific 3D printing.

Dental Implants , Orbital Fractures , Reconstructive Surgical Procedures , Child , Humans , Imaging, Three-Dimensional , Orbit/diagnostic imaging , Orbit/surgery , Orbital Fractures/diagnostic imaging , Orbital Fractures/surgery , Printing, Three-Dimensional
Head Face Med ; 17(1): 41, 2021 Sep 15.
Article En | MEDLINE | ID: mdl-34526052

BACKGROUND: Orbital decompression surgery is frequently the last therapeutic measure in the surgical treatment of endocrine orbitopathy (EO). Additional rehabilitative and corrective surgical treatments are often used to improve the resulting eyelid stigmata, such as an increased lid aperture and scleral show. The aim of the study was to evaluate the effect of adjunctive surgical procedures after orbital decompression surgery in patients with EO. METHODS: A total of 120 orbitae from 65 patients with EO from 2010 to 2020 at a tertiary care center in Germany were retrospectively evaluated. Ocular surface area (OSA) and vertical palpebral fissures were three-dimensionally analyzed at the following stages: presurgical decompression, postsurgical decompression, and post-adjunctive surgical procedures. For the analysis of vertical palpebral fissures, predefined vertical line distances were measured on the upper and lower lids in the central, medial, and lateral pupillary regions. RESULTS: The initial OSA was 2,98 ± 0.85 cm2, and it decreased significantly after decompression surgery to 2.52 ± 0.62 cm2. After adjunct surgical procedures, OSA further decreased to 2,31 ± 0,55 cm2. Furthermore, a statistically significant reduction in all pupillary parameters was noted after each treatment step. More lid-lengthening procedures were performed on the lower lid than on the upper lid. Canthoplasty (n = 13) was the most frequently performed procedure during rehabilitation. CONCLUSION: Surgical decompression surgery improves OSA and leads to a significant reduction in lid aperture. Adjunctive surgical procedures, addressing the upper and lower lid, have a significant influence on the ongoing clinical course and contribute to a reduction in OSA.

Graves Ophthalmopathy , Decompression, Surgical , Graves Ophthalmopathy/surgery , Humans , Orbit/surgery , Retrospective Studies
Oper Neurosurg (Hagerstown) ; 21(4): E386-E391, 2021 09 15.
Article En | MEDLINE | ID: mdl-34333660

BACKGROUND AND IMPORTANCE: Orbitocranial penetrating injury (OPI) is associated with neurological, infectious, and vascular sequalae. This report describes unique application of an orbitofrontal craniotomy through a supraciliary approach to remove a wooden stick penetrating through the orbit and frontal lobe, postoperative management, and antimicrobial therapy. CLINICAL PRESENTATION: A 51-yr-old male presented after a tree branch penetrated beneath his eye. He had no loss of consciousness and was neurologically intact with preserved vision and ocular motility. Computed tomography (CT) and CT angiogram revealed an isodense hollow cylindrical object penetrating though the left orbit and left frontal lobe. The object extended into the right lateral ventricle, abutting the left anterior cerebral artery. There was minimal intraventricular hemorrhage without arterial injury. The patient was treated with broad-spectrum antimicrobial coverage. The foreign body was removed and the dural defect repaired via an orbitofrontal craniotomy through a supraciliary eyebrow incision. He was treated with an extended course of antimicrobial therapy, and after 18 mo remained neurologically intact. CONCLUSION: OPI are a subset of penetrating brain injuries with potential for immediate injury to neurovascular structures and delayed complications including cerebrospinal fluid leak and infection. Treatment includes attempted complete removal of the foreign body and antimicrobial therapy. An orbitofrontal craniotomy through a supraciliary eyebrow incision may be effective in selected patients.

Craniotomy , Trees , Frontal Lobe/diagnostic imaging , Frontal Lobe/surgery , Humans , Orbit/diagnostic imaging , Orbit/surgery , Prefrontal Cortex
J Neurol Surg A Cent Eur Neurosurg ; 82(6): 585-593, 2021 Nov.
Article En | MEDLINE | ID: mdl-34384130

BACKGROUND: Different surgical approaches have been developed to manage lesions of the anterior and middle skull base areas. Frontal, pterional, bifrontal, and fronto-orbito-zygomatic approaches are traditionally used to reach these regions. With advancements in the neurosurgical field, skull opening should be simple and as minimally invasive as possible, tailored on the surgical corridor to the target. The supraorbital approach and the "keyhole" concept have been introduced and popularized by Axel Perneczky starting from 1998 and are now considered a part of everyday practice. The extended possibilities of this surgical route, considering the reachable targets and surgical limits, are described and systematically analyzed, including a description of the salient surgical anatomy, presenting different illustrative cases. METHODS AND RESULTS: Different illustrative cases are presented and discussed to underline the potentials and limits of the minimally invasive subfrontal approach (MISFA) and the possibilities to tailoring the craniotomy on the basis of the targets: extra-axial lesions with different localizations (anterior roof of the orbit, olfactory groove, tuberculum sellae, medial third of the sphenoid wing, anterior and posterior clinoid process), deeper intra-axial lesions (gyrus rectus, medial temporal lobe-uncus-amygdala-anterior hippocampus), and vascular lesions (anterior communicating aneurysm). Each case has been preoperatively planned considering the anatomical and radiologic features and using virtual simulation software to tailor the best possible corridor to reach the surgical target. CONCLUSIONS: The MISFA is a safe multicorridor approach that can be used efficiently to manage lesions of the anterior and middle skull base areas with extremely low approach-related morbidity.

Cranial Fossa, Anterior , Neurosurgical Procedures , Craniotomy , Humans , Orbit/surgery , Temporal Lobe/surgery
Comput Biol Med ; 137: 104791, 2021 10.
Article En | MEDLINE | ID: mdl-34464850

BACKGROUND: To assess the accuracy with which CAD/CAM-fabricated patient-specific titanium implants (PSI) are positioned for inferior and/or medial orbital wall reconstruction without the use of intraoperative navigation. METHODS: Patients who underwent a primary reconstruction of the orbital walls with PSI due to fractures were enrolled in this retrospective cohort analysis. The primary outcome variables were the mean surface distances (MSD) between virtually planned and postoperative PSI position and single linear deviations in the x-, y- and z-axis at corresponding reference points. Secondary outcome variables included demographic data, classification of orbital wall defects and clinical outcomes. RESULTS: A total of 33 PSI (orbital floor n = 22; medial wall, n = 11) were examined in 27 patients. MSD was on a comparable level for the orbital floor and medial wall (median 0.39 mm, range 0.22-1.53 mm vs. median 0.42 mm, range 0.21-0.98 mm; p = 0.56). Single linear deviations were lower for reconstructions of the orbital floor compared to the medial wall (median 0.45 vs. 0.79 mm; p < 0.05). There was no association between the occurrence of diplopia and the accuracy level (p = 0.418). CONCLUSIONS: Free-hand positioning of PSI reaches a clinically appropriate level of accuracy, limiting the necessity of navigational systems to selected cases.

Orbital Fractures , Reconstructive Surgical Procedures , Humans , Orbit/surgery , Orbital Fractures/diagnostic imaging , Orbital Fractures/surgery , Prostheses and Implants , Retrospective Studies
Head Neck ; 43(12): 4022-4029, 2021 12.
Article En | MEDLINE | ID: mdl-34396617

The pterygopalatine fossa contains a dense and complex array of neurovascular structures vulnerable to accidental surgical injury. This study aims to describe a novel landmark, the orbito-pterygo-sphenoidal ligament (OPSL), and implications of this structure for surgery in the pterygopalatine fossa and the inferior orbital fissure. Six cadaveric specimens (12 sides) were dissected using an endonasal approach to expose the periosteal layers associated with the pterygopalatine fossa and orbit. The thickened triangular-shaped ligament at their confluence was termed the OPSL. Dimensions of its lateral, inferior, and medial borders were measured, and their anatomical relationships defined. The pterygopalatine ganglion and the maxillary nerve lie immediately inferior and deep into the OPSL. The superior aspect of the posterior nasoseptal artery and nerve are covered by the medial OPSL. The lateral and inferior borders of the OPSL are contiguous with the periorbita and the periosteum of the pterygopalatine fossa, respectively. Along the medial border of the ligament, the openings of the palatovaginal fissure, vidian canal, and foramen rotundum were sequentially identified in a medial to lateral trajectory. The length of the lateral, inferior, and medial borders of the triangular OPSL were 13.25 ± 0.62, 14.25 ± 0.45, and 12.08 ± 0.90 mm, respectively. The OPSL is a thick, triangular-shaped fascial confluence, which may serve as a landmark for procedures within the pterygopalatine fossa and the inferior orbital fissure.

Orbit , Pterygopalatine Fossa , Cadaver , Humans , Ligaments/surgery , Neurosurgical Procedures , Orbit/surgery , Pterygopalatine Fossa/surgery
Indian J Ophthalmol ; 69(9): 2524-2526, 2021 Sep.
Article En | MEDLINE | ID: mdl-34427258

We describe an objective method to measure the volume of a dermis-fat graft (DFG) implant for socket reconstruction. We reviewed the charts of 10 patients undergoing dermis fat grafting as a primary or secondary implant for anophthalmic socket reconstruction between January 2018 and December 2019. The amount of the DFG required to replace the volume of an appropriate spherical implant for the operated eye was predetermined. The volume of the DFG implant was measured by the water displacement method as per the Archimedes principle. Patient demographics, complications, and the outcome were analyzed regarding cosmesis and volume replacement. All patients were satisfied with the final cosmesis. Follow-up ranged from 6 to 18 months (mean 10.7 months). Thus, we concluded that the water displacement method is a simple and easy procedure to objectively determine the amount of the autologous DFG needed to replace the volume in an anophthalmic socket.

Anophthalmos , Orbital Implants , Dermis , Eye, Artificial , Humans , Orbit/surgery
BMC Ophthalmol ; 21(1): 290, 2021 Jul 29.
Article En | MEDLINE | ID: mdl-34325667

BACKGROUND: To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. METHODS: Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). RESULTS: There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334-0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were - 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. CONCLUSIONS: No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.

Orbit , Decompression , Humans , Male , Orbit/diagnostic imaging , Orbit/surgery , Retrospective Studies , Switzerland
J Craniofac Surg ; 32(8): 2851-2853, 2021.
Article En | MEDLINE | ID: mdl-34231507

ABSTRACT: Orbital reconstruction has traditionally been accomplished utilizing different techniques developed for this purpose and has been modified and improved throughout the years. However, there is a high rate of complications associated with eye globe positioning and/or migration of implants, which has created the need to continue to improve these techniques to decrease the frequency of complications. On the other hand, techniques that involve an endoscopic approach and technologies that use virtual surgical planning and three-dimensional model impressions are being used more often to decrease complication rates and seek better surgical outcomes. Combining these 2 methods results in endoscopically integrated virtual surgical navigation. When used for orbital reconstruction, it can be a great alternative and can be useful to decrease the risk of complications associated with this procedure. Therefore, this technical note aims to describe the integration of these 2 techniques into the same instrument to demonstrate the synergy of their benefits when used together.

Eye Injuries , Orbital Fractures , Reconstructive Surgical Procedures , Surgery, Computer-Assisted , Humans , Orbit/surgery , Orbital Fractures/diagnostic imaging , Orbital Fractures/surgery
Head Neck ; 43(10): 3238-3244, 2021 10.
Article En | MEDLINE | ID: mdl-34268827

Orbital exenteration is a disfiguring procedure that often results in free tissue transfer for reconstructive purposes. The reconstructive focus is the obliteration of dead space while sparing the nasal airway, particularly if the medial orbital wall was resected. Prolapse of transferred tissue into the nasal airway may cause breathing difficulties drastically compromising quality of life. The objective of this study was to demonstrate the effectiveness and feasibility of temporary nasal septum splints as mechanical support for transferred tissue, to prevent airway obstruction. This novel application technique was employed in three patients between 2017 and 2018. No flap loss or sino-orbital fistulas were observed. On postoperative MRI and endoscopy, a patent nasal airway was observed at all times. Temporary nasal splinting in combination with free tissue transfer proved to be a simple, but effective reconstructive option for securing the nasal airway following orbital exenteration with resection of the medial orbital wall.

Free Tissue Flaps , Reconstructive Surgical Procedures , Humans , Orbit/surgery , Orbit Evisceration , Quality of Life
BMJ Case Rep ; 14(7)2021 Jul 09.
Article En | MEDLINE | ID: mdl-34244186

A 37-year-old Indian female presented with forward protrusion of left eye for one week, associated with progressive diminution of vision. The patient had undergone sinus surgery for nasal polyposis a year ago. On examination, there was severe proptosis and limitation of extraocular movements in all gazes. CT-scan revealed a heterogeneous expansile mass, arising from left fronto-ethmoidal sinus, infiltrating left orbit. MRI showed T2-hyperintense, peripherally enhancing areas in bilateral nasal cavity (right >left), bilateral ethmoidal sinuses and frontal, sphenoidal and maxillary sinuses. Otorhinolaryngology consultation was sought and in view of vision threatening proptosis - with likely orbital compartment syndrome - emergent endoscopic guided exploration and orbital decompression was undertaken. Rapid relief of signs and symptoms was achieved, with normal vision, extraocular movements and resolution of proptosis. Cytology and microbiology ruled out infectious or malignant aetiology and helped in resolving a diagnostic dilemma. Histopathology confirmed the diagnosis of mucopyocele and follow-up period was uneventful.

Compartment Syndromes , Exophthalmos , Mucocele , Adult , Ethmoid Sinus/diagnostic imaging , Ethmoid Sinus/surgery , Exophthalmos/etiology , Female , Humans , Mucocele/diagnosis , Mucocele/diagnostic imaging , Orbit/diagnostic imaging , Orbit/surgery
Acta Neurochir (Wien) ; 163(12): 3433-3437, 2021 12.
Article En | MEDLINE | ID: mdl-34231050

BACKGROUND: The endoscopic endonasal approach provides an option to approach the medial and inferior orbital apex, with less manipulation of intraorbital structures. METHOD: We described the advantages, complications, caveats, and indications of the endoscopic endonasal approach to the orbital apex. An intraorbital extraconal cavernous malformation is shown as example. CONCLUSION: The endoscopic endonasal approach is a good corridor to the medial and inferior orbital apex, providing good exposure and little manipulation of the intraorbital contents.

Endoscopy , Nose , Humans , Nose/surgery , Orbit/diagnostic imaging , Orbit/surgery
Br J Oral Maxillofac Surg ; 59(7): 826-830, 2021 09.
Article En | MEDLINE | ID: mdl-34256960

Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.

Dental Implants , Orbital Fractures , Reconstructive Surgical Procedures , Surgery, Computer-Assisted , Feasibility Studies , Humans , Orbit/surgery , Orbital Fractures/surgery , Surgical Instruments