Development and demonstration of a novel computer planning solution for predefined correction of enophthalmos in anophthalmic patients using prebended 3D titanium-meshes--a technical note.

Ablative surgery of the orbit is often associated with dramatic changes in facial geometry. Surgical intervention is often necessary to correct the functional and esthetic appearance in those patients who are anophthalmic, having an intact eyelid appearance and an orbital prosthesis. The outcome of the surgical correction depends on the shape of the orbital implants and their adequate placement. In the case of comparatively small rearrangements, the effect of implants on soft tissues can be estimated by surgeons on the basis of their experience. However, large deformities in complex cases (including large deformation of soft tissue or asymmetry) can be hardly predicted on the basis of simple empirical considerations. The purpose of the present technical note was to describe a new procedure of inverse design of customized orbital titanium meshes. To demonstrate this procedure, an anophthalmic patient with superior sulcus deformity and enophthalmos was enrolled. The volume and structure of the extraocular muscles, soft tissue, and bony structure of the orbital walls were examined using high-resolution multislice computed tomography. Next, a geometric model of the patient's anatomy was generated from the tomography data. Afterward, the orbital prosthesis was virtually relocated to a new position. Then, the desired correction of the particular soft tissue regions was performed using virtual sculpturing tools. Next, the deformation of the soft tissues and initial prosthesis boundaries were computed from the predefined displacements of the relocated tissue regions with the help of the Finite Element Method. The differential volume between the initial and designated position of the orbital prosthesis yielded the preferred implant shape required to effect the desired correction of soft tissue. During surgery, the preplanned position of the customized titanium meshes was guided using a navigation system. Although the inverse design of custom-tailored titanium meshes for precision treatment of severe enophthalmos in anophthalmic patients appears to be a promising approach, it has rarely been applied in the past because of the technological complexity and additional time required. With the present study, we have launched a series of clinical evaluations of this novel method. To date, scientific evidence and trials showing a predictable simulation using an inverse finite element approach in the correction of severe enophthalmos in anophthalmic patients with computer-assisted fabricated individual titanium meshes for reconstruction of orbital walls have been rare.