Patient Specific Implants: Reconstruction of Orbital Defects With Custom PEEK Implants

Complex orbital wall defects can pose significant reconstruction dilemma for the reconstructive surgeon.  The failure to accurately restore intra-orbit volume can have significant consequences for the patient, namely visual disturbance that may rang from annoying to debilitating. 

To solve this problem, we looked at patients who had complex orbital wall defects and failed initial management with stock titanium plating techniques. Patient’s who presented with continued visual changes and clinical evidence of dystopia and enophthalmos where included. Material options for orbital implants are discussed and rational for selection of custom PEEK implants are discussed.

For these patient a custom polyetheretherketone implant was fabricated using Computed Tomography and CAD-CAM technology.  Sample size of 3-5 patients with analysis of pre-operative and post-operative CT scan internal orbit dimensions of the affected side as compared to the unaffected orbit.  In addition, a subjective patient questionnaire inquiring about past, current symptoms and overall satisfaction with the surgery where obtained.

Final data statistics are pending at this time but initial analysis shows an overall more anatomical reduction and symmetric volume relationship with the patient specific PEEK implant as well as increased patient satisfaction. Thus we conclude that patient specific PEEK implants are a good option for reconstruction of orbital defects in individuals who have had non-anatomical reduction and are experience continued visual disturbance after placement of stock implants.  

 References

1.        Baino F. Biomaterials and implants for orbital floor repair. Acta Biomater. 2011;7:3248-3266. doi:10.1016/j.actbio.2011.05.016.

2.        Bratton EM, Durairaj VD. Orbital implants for fracture repair. Curr Opin Ophthalmol. 2011;22:400-406. doi:10.1097/ICU.0b013e3283499409.

3.        Gander T, Essig H, Metzler P, Lindhorst D, Dubois L. Patient speci fi c implants ( PSI ) in reconstruction of orbital fl oor and wall fractures. 2015;43:126-130.

4.        Gosau M, Schöneich M, Draenert FG, Ettl T, Driemel O, Reichert TE. Retrospective analysis of orbital floor fractures-complications, outcome, and review of literature. Clin Oral Investig. 2011;15:305-313. doi:10.1007/s00784-010-0385-y.

5.        Kozakiewicz M, Szymor P. Comparison of pre-bent titanium mesh versus polyethylene implants in patient specific orbital reconstructions. Head Face Med. 2013;9(1):32. doi:10.1186/1746-160X-9-32.

6.        Liss J, Stefko ST, Chung WL. Orbital Surgery: State of the Art. Oral Maxillofac Surg Clin North Am. 2010;22(1):59-71. doi:10.1016/j.coms.2009.11.006.

7.        Ridgway EB, Chen C, Lee BT. Acquired entropion associated with the transconjunctival incision for facial fracture management. J Craniofac Surg. 2009;20(5):1412-1415. doi:10.1097/SCS.0b013e3181aee3ee.

8.        Parthasarathy J. 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg. 2014;4(1):9. doi:10.4103/2231-0746.133065.