Rüdiger M Zimmerer1, Nils-Claudius Gellrich1, Sophie von Bülow1, Edward Bradley Strong2, Edward Ellis3, Maximilian E H Wagner4, Gregorio Sanchez Aniceto5, Alexander Schramm6, Michael P Grant7, Lim Thiam Chye8, Alvaro Rivero Calle5, Frank Wilde6, Daniel Perez3, Gido Bittermann9, Nicholas R Mahoney7, Marta Redondo Alamillos5, Joanna Bašić6, Marc Metzger9, Michael Rasse10, Jan Dittman1, Elke Rometsch11, Kathrin Espinoza12, Ronny Hesse13, Carl-Peter Cornelius13. 1. Medizinische Hochschule Hannover, Mund-, Kiefer- und Gesichtschirurgie, Carl-Neubergstr. 1, 30625, Hannover, Germany. 2. UC Davis Health System, Department of Otolaryngology-Head and Neck Surgery, 2521 Stockton Blvd., Suite 7200, Sacramento, CA 95817, CA, USA. 3. University of Texas Health Science Center at San Antonio, Dept. of Oral and Maxillofacial Surgery, 7703 Floyd Curl Dr., San Antonio, TX 78229, TX, USA. 4. Universitätsspital Zürich, Klinik für Mund-, Kiefer- und Gesichtschirurgie, Frauenklinikstrasse 24, 8091, Zürich, Switzerland. 5. 12 de Octubre University Hospital, Cirurgia Maxillofacial, Av. De Cordoba s/n, 28041, Madrid, Spain. 6. Bundeswehrkrankenhauses Ulm, Department of Oral, Maxillofacial and Plastic Facial Surgery, Oberer Eselsberg 40, 89081, Ulm, Germany. 7. Johns Hopkins Hospital, The Wilmer Eye Institute, 600 North Wolfe Street, Baltimore, MD 21287, MD, USA. 8. National University Hospital, Division of Plastic Surgery, Lower Kent Ridge Road, 119074, Singapore. 9. Albert-Ludwigs-Universität, Mund-, Kiefer- und Gesichtschirurgie, Hugstetter Straße 55, 79106, Freiburg i.Br., Germany. 10. Medizinische Universitätsklinik Innsbruck, Universitätsklinik für Mund- Kiefer- und Gesichtschirurgie, Zahn,- Mund- und Kieferheilkunde, Anichstrasse 35, 6020 Innsbruck, Austria. 11. AO Foundation, AO Clinical Investigation and Documentation (AOCID), Stettbachstr. 6, 8600, Dübendorf, Switzerland. Electronic address: elke.rometsch@aofoundation.org. 12. AO Foundation, AO Clinical Investigation and Documentation (AOCID), Stettbachstr. 6, 8600, Dübendorf, Switzerland. 13. Klinikum der LMU Muenchen, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Lindwurmstr. 2a, 80337, München, Germany.
Abstract
PURPOSE: Reconstruction of orbital wall fractures is demanding and has improved dramatically with the implementation of new technologies. True-to-original accuracy of reconstruction has been deemed essential for good clinical outcome, and reasons for unfavorable clinical outcome have been researched extensively. However, no detailed analysis on the influence of plate position and surface contour on clinical outcome has yet been published. MATERIALS AND METHODS: Data from a previous study were used for an ad-hoc analysis to identify predictors for unfavorable outcome, defined as diplopia or differences in globe height and/or globe projection of >2 mm. Presumed predictors were implant surface contour, aberrant implant dimension or position, accuracy of reconstructed orbital volume, and anatomical fracture topography according to the current AO classification. RESULTS: Neither in univariable nor in multivariable regression models were unfavorable clinical outcomes associated with any of the presumed radiological predictors, and no association of the type of implant, i.e., standard preformed, CAD-based individualized and non-CAD-based individualized with its surface contour could be shown. CONCLUSION: These data suggest that the influence of accurate mechanical reconstruction on clinical outcomes may be less predictable than previously believed, while the role of soft-tissue-related factors may have been underestimated.
PURPOSE: Reconstruction of orbital wall fractures is demanding and has improved dramatically with the implementation of new technologies. True-to-original accuracy of reconstruction has been deemed essential for good clinical outcome, and reasons for unfavorable clinical outcome have been researched extensively. However, no detailed analysis on the influence of plate position and surface contour on clinical outcome has yet been published. MATERIALS AND METHODS: Data from a previous study were used for an ad-hoc analysis to identify predictors for unfavorable outcome, defined as diplopia or differences in globe height and/or globe projection of >2 mm. Presumed predictors were implant surface contour, aberrant implant dimension or position, accuracy of reconstructed orbital volume, and anatomical fracture topography according to the current AO classification. RESULTS: Neither in univariable nor in multivariable regression models were unfavorable clinical outcomes associated with any of the presumed radiological predictors, and no association of the type of implant, i.e., standard preformed, CAD-based individualized and non-CAD-based individualized with its surface contour could be shown. CONCLUSION: These data suggest that the influence of accurate mechanical reconstruction on clinical outcomes may be less predictable than previously believed, while the role of soft-tissue-related factors may have been underestimated.
Authors: Nils-Claudius Gellrich; Jan Dittmann; Simon Spalthoff; Philipp Jehn; Frank Tavassol; Rüdiger Zimmerer Journal: J Maxillofac Oral Surg Date: 2019-06-12