Computer-assisted extracorporeal orbital reconstruction after optic nerve decompression by removal of sphenoid bone.

Abstract

The removal of sphenoid bone parts was performed by the admitting neurosurgeons on a patient who presented an optic nerve compression syndrome. Beside the orbital trauma, an extensive midfacial trauma was sustained with dislocated multifractures of the zygomatic complex. In a secondary procedure, the orbital cavity was reconstructed successfully using 3 different methods of computer-assisted surgery. First, the reconstruction of the zygomatic complex was controlled intraoperatively by a virtual model obtained by mirroring the unaffected side to the affected side. Second, extracorporeal bone parts were virtually preoperatively relocated and orientated. The reconstruction of the orbital cavity by the insertion of these bony fragments was performed intraoperatively as planned after the zygomatic complex reconstruction. Third, the virtual reconstruction of the orbital floor was performed using preoperatively individually bent and preformed orbital titanium mesh. Combinations of these methods demonstrate the practical and high value of computer-assisted surgery in complex reconstructive craniofacial surgery.