Combined Orbital Reconstruction with Plate Osteosynthesis, Polydioxanone Foil and Individual CAD/CAM-Implant in a Complex Nasoorbitoethmoid Fracture

Introduction: Orbital reconstruction can be performed by using different kinds of alloplastic materials. Especially in solitary fractures of the orbital floor, the application of individual prefabricated CAD/CAM-implants represents a novel and increasingly used procedure. In this case report, we show the application of an CAD/CAM-implant in a complex nasoorbitoethmoid fracture combined with plate osteosynthesis and Polydioxanone foil. Case report: We report about the case of a 28-year-old professional football player with craniocerebral injury and a midfacial fracture due to collision in a football match. Preoperative CT-diagnostics showed a displaced and multiple fragmental fracture of the naso-ethmoidal complex involving the inferior orbital margin, medial orbital wall and orbital floor. Repositioning and osteosynthesis of the complex fracture was done over intra- and extraoral access. The reconstruction of the orbital floor was realized by using an individual CAD/CAM-implant in navigation-guided surgery. The medial orbital wall was reconstructed with a Polydioxanone foil. Results: By virtual mirroring of the opposite orbital frame in preoperative planning, it was possible to prefabricate an individual CAD/CAM-implant in order to reconstruct the fractured orbital floor. Despite the complex and difficult fracture of the naso-ethmoidal complex with multiple fragments, anatomical correct reconstruction of the displaced inferior orbital margin could be successfully done through the preoperative planned repositioning site of the CAD/CAM-implant. The accurate reconstruction of the orbital floor allowed intraoperative gain of time and and resulted in good rehabilitation of the patient. Conclusion: Individual prefabricated orbital floor CAD/CAM-implants can be successfully used in complex fractures and may be combined with other methods and materials. By correct planning, the described procedure can be advantageously in surgery and postoperative outcome. Keywords: CAD/CAM-implant, Reconstruction of the orbit, Orbital floor fracture, Nasoorbitoethmoid fracture