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Comparison of the Outcomes of Complex Orbital Fracture Repair with and without a Surgical Navigation System: A Prospective Cohort Study with Historical Controls

Zavattero, Emanuele M.D., Ph.D.; Ramieri, Guglielmo M.D., D.D.S.; Roccia, Fabio M.D.; Gerbino, Giovanni M.D., D.D.S.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 957–965
doi: 10.1097/PRS.0000000000003229
Pediatric/Craniofacial: Original Articles
Coding Perspective

Background: In severe orbital fractures, restoration of orbital shape and volume is required to avoid diplopia and posttraumatic enophthalmos. The purpose of this study was to compare outcomes between navigation-aided and conventional techniques for complex unilateral orbital fractures using titanium mesh.

Methods: The outcomes and the computed tomography–measured orbital volume of two groups of orbital complex unilateral reconstruction cases were compared. The study group consisted of a consecutive cohort of unilateral severe orbital fracture that underwent surgery with the aid of a Brainlab navigation system. A historical control group was composed of consecutive operations performed immediately before the beginning of navigation system use. A total of 55 operations were then identified and studied for patient characteristics, diplopia and globe position, preoperative and postoperative orbital volumes, complications, need for revision surgery, and the surgeon’s performance.

Results: Postoperative diplopia severity was lower in the study group than in the control group. Orbital volume analysis showed that reconstructed orbital volume in the study group was closer to unaffected orbital volume compared with the control group. Significant orbital volume reduction in the reconstructed orbit could be achieved in the study group, and there was no significant reduction in the control group compared with the unaffected side. The globe projection was higher compared with the preoperative situation in the study group than in the control group. The navigational platform could also contribute to reduce the learning curve.

Conclusion: This study demonstrated that computer-assisted techniques improve outcomes compared with conventional techniques.


Supplemental Digital Content is available in the text.Coding Perspective for this Article is on Page 964.

Torino, Italy

From the Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e della Scienza Hospital, University of Torino.

Received for publication March 13, 2016; accepted September 2, 2016.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

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Emanuele Zavattero, M.D., Ph.D., Surgical Science Department, Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, Via Genova 3, 10100 Torino, Italy,

©2017American Society of Plastic Surgeons