Is there more to the clinical outcome in posttraumatic reconstruction of the inferior and medial orbital walls than accuracy of implant placement and implant surface contouring? A prospective multicenter study to identify predictors of clinical outcome. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Zimmerer, Rüdiger M.; Gellrich, Nils-Claudius; von Bülow, Sophie; Strong, Edward Bradley; Ellis, Edward; Wagner, Maximilian E.H.; Sanchez Aniceto, Gregorio; Schramm, Alexander; Grant, Michael P.; Thiam Chye, Lim; Rivero Calle, Alvaro; Wilde, Frank; Perez, Daniel; Bittermann, Gido; Mahoney, Nicholas R.; Redondo Alamillos, Marta; Bašić, Joanna; Metzger, Marc; Rasse, Michael; Dittman, Jan; Rometsch, Elke; Espinoza, Kathrin; Hesse, Ronny; Cornelius, Carl-Peter
• Is Part Of: Journal of cranio-maxillofacial surgery. Volume 46:Issue 4(2018)
• Page Start: 578
• Page End: 587
• Publication Date: 2018-04
• Subjects: Orbital fracture -- Blow-out fracture -- Orbital implant -- Clinical outcome -- Predictor -- Regression analysis; Skull -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; Maxilla -- surgery -- Periodicals; Face -- surgery -- Periodicals; Skull -- surgery -- Periodicals; Oral Surgical Procedures -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Periodicals; Surgery, Oral -- Periodicals; Electronic journals; 617.514
• DOI: 10.1016/j.jcms.2018.01.007
• Languages: English
• ISSNs: 1010-5182

Abstract

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.