Patient-Specific Implants in Post-traumatic Orbital Reconstruction: A Systematic Review.

BACKGROUND

Orbital fractures commonly result in functional and esthetic deficits, demanding precise reconstruction of orbital volume and globe position. Patient-specific implants (PSIs) have emerged as promising solutions, yet their definitive clinical and cost-effectiveness benefits remain debated.

PURPOSE: The study purpose was to estimate and compare orbital volume restoration, globe position, functional outcomes, and complications between PSI versus conventional orbital reconstruction.

STUDY SELECTION: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science from inception to May 2025 identified studies comparing PSIs with conventional orbital reconstruction techniques in adults with post-traumatic orbital defects. Studies exclusively reporting technical aspects, pediatric samples, or nontraumatic defects were excluded. Of 385 identified studies, 23 met the inclusion criteria.

RESULTS

The included studies involved 1,222 subjects. PSIs demonstrated significantly better orbital volume restoration compared to conventional methods (mean volume difference: PSI, 0.73 ± 0.28 cm3; conventional, 1.54 ± 0.38 cm3, P < .05). Globe position outcomes were also consistently better in PSI groups, with significantly reduced persistent enophthalmos (PSI 7.3% vs conventional 18.2%, P = .03). Functional outcomes, specifically persistent diplopia, were significantly lower with PSI (PSI 11.7% vs conventional 30.1%, P = .01). Revision rates were also significantly reduced with PSI usage (PSI 5.9% vs conventional 13.7%, P = .01). Despite higher initial costs, PSI reduced operative times by an average of 15.7 minutes, which may offset overall treatment expenses.

CONCLUSIONS AND RELEVANCE: PSIs offer superior outcomes in orbital volume restoration, globe positioning, and reduced complication and revision rates compared to conventional reconstruction. These findings strongly support PSI utilization in complex post-traumatic orbital reconstruction, particularly when integrated with intraoperative navigation systems. Further research, especially prospective randomized studies with long-term follow-up, is needed to strengthen these recommendations.