A MODERN WORKFLOW TO A RATIONAL USE OF TECHNOLOGY IN ORBITAL RECONSTRUCTION
Authors:
Mirabella S.1,2, Canzi G.3, Sozzi D.2, Novelli G.2
Affiliation:
1 Maxillo-Facial Surgery Specialization School, University of Milan
2 Maxillo-Facial Division, IRCCS San Gerardo Dei Tintori, Monza – University of Milano Bicocca
3 Maxillo-Facial Division, Grande Ospedale Metropolitano Niguarda, Milan
Doi: 10.54936/haoms242p93
ABSTRACT:
Introduction: The orbital anatomy is one of the most complex in the human body, it not only contains entirely the sense of sight but also deeply affects the relationship life. Several pathologies can present in this anatomical area: primarily traumatic process can cause bony fractures resulting in a distortion of the anatomy, neoplasm, inflammatory process, vascular malformation and so on.
Surgery can be challenging, placing the surgeon in stressful procedures if not adequately trained or supported by novel tools such as informatic ones.
We propose a clinical and radiological diagnostic-therapeutical algorithm that could be used as a guide to discriminate cases that need more assets from the ones that can be treated with traditional surgery.
Material and Methods: A retrospective data analysis was conducted, data were collected prospectively. Patients were treated in two maxillo-facial unit from 2010 and 2022. Only patients with monoliteral orbital reconstruction were included to verify the accuracy of the reconstruction. Patients were stratified based on type of reconstruction used and the Jaquìery Classification of the orbital lesion. The primary outcome was to assess the best degree of technology tool for each group of patients, measuring accuracy of the reconstruction, surgical time, number of reinterventions. Accuracy of the reconstruction was evaluated by comparing the postoperative volume of the affected orbit with the contralateral (non-affected).
Results: 229 patients were admitted in the study, 35 characterized by Jaquìery class I, 89 class II, 68 class III, 33 class IV e 4 class IV. In patients with lower grade of anatomical defects (Class I, Class II) the use of technological aids shows no noticeable improvement while in higher grade (Class III and IV) the use of CAS shows a reduction in terms of operating time and number of reinterventions and higher accuracy in volume.
Conclusion: The use of Computer Assisted Surgery (CAS), in the last decades has become more and more common due to the ability to allow a better understanding during the preoperative phase along with useful tools during the procedure itself that enable operators to obtain more accurate and reproducible results.CAS instruments, currently, can be energy and money – consuming so their use is often limited in some cases even if no study had found clear indication whether or not more resources can be justified. The proposed work-flow can be useful to help operators choose the correct option to asses different cases, tailoring the treatment based on clinical and radiological characteristics.
KEY WORDS:
Authors:
Mirabella S.1,2, Canzi G.3, Sozzi D.2, Novelli G.2
Affiliation:
1 Maxillo-Facial Surgery Specialization School, University of Milan
2 Maxillo-Facial Division, IRCCS San Gerardo Dei Tintori, Monza – University of Milano Bicocca
3 Maxillo-Facial Division, Grande Ospedale Metropolitano Niguarda, Milan
Doi: 10.54936/haoms242p93
ABSTRACT:
Introduction: The orbital anatomy is one of the most complex in the human body, it not only contains entirely the sense of sight but also deeply affects the relationship life. Several pathologies can present in this anatomical area: primarily traumatic process can cause bony fractures resulting in a distortion of the anatomy, neoplasm, inflammatory process, vascular malformation and so on.
Surgery can be challenging, placing the surgeon in stressful procedures if not adequately trained or supported by novel tools such as informatic ones.
We propose a clinical and radiological diagnostic-therapeutical algorithm that could be used as a guide to discriminate cases that need more assets from the ones that can be treated with traditional surgery.
Material and Methods: A retrospective data analysis was conducted, data were collected prospectively. Patients were treated in two maxillo-facial unit from 2010 and 2022. Only patients with monoliteral orbital reconstruction were included to verify the accuracy of the reconstruction. Patients were stratified based on type of reconstruction used and the Jaquìery Classification of the orbital lesion. The primary outcome was to assess the best degree of technology tool for each group of patients, measuring accuracy of the reconstruction, surgical time, number of reinterventions. Accuracy of the reconstruction was evaluated by comparing the postoperative volume of the affected orbit with the contralateral (non-affected).
Results: 229 patients were admitted in the study, 35 characterized by Jaquìery class I, 89 class II, 68 class III, 33 class IV e 4 class IV. In patients with lower grade of anatomical defects (Class I, Class II) the use of technological aids shows no noticeable improvement while in higher grade (Class III and IV) the use of CAS shows a reduction in terms of operating time and number of reinterventions and higher accuracy in volume.
Conclusion: The use of Computer Assisted Surgery (CAS), in the last decades has become more and more common due to the ability to allow a better understanding during the preoperative phase along with useful tools during the procedure itself that enable operators to obtain more accurate and reproducible results.CAS instruments, currently, can be energy and money – consuming so their use is often limited in some cases even if no study had found clear indication whether or not more resources can be justified. The proposed work-flow can be useful to help operators choose the correct option to asses different cases, tailoring the treatment based on clinical and radiological characteristics.
KEY WORDS: