Contemporary Techniques in Orbital Reconstruction: A Review of the Literature and Report of a Case Combining Surgical Navigation, Computer-Aided Surgical Simulation, and a Patient-Specific Implant.

PURPOSE: Complex orbital fractures can be surgically challenging because the orbital cavity contains several vital anatomic structures and visibility is limited. We present a case in which computer-aided surgical simulation (CASS), surgical navigation (SN), and a patient-specific implant (PSI) were used. Furthermore, the reported data regarding this topic were systematically searched and investigated. PATIENTS AND METHODS: A patient with a complex, failed orbital reconstruction was referred to our department. Despite the use of advanced tools, including a preformed PSI using a 1:1 mirrored, individual 3-dimensional model, several challenges remained. A systematic search of the relevant databases, scientific journals, and bibliographies of the included reports was conducted. Clinical studies involving CASS and SN in the treatment of at least 5 patients reported between 2016 and 2018 were included. RESULTS: The final reconstruction was planned virtually, and a milled PSI was produced and implanted under guidance of SN. The clinical outcome was acceptable to the patient. The literature search showed that superior results can be obtained when CASS and SN are involved in the treatment regimen. The average technical accuracy for SN has been reported to be less than 1 mm, and volume restoration has been reported to be significantly superior to that achieved with traditional methods. CONCLUSIONS: New technological advancements such as CASS involving SN seem to improve the outcomes of orbital reconstruction, especially in complex cases. Furthermore, planning, execution, and evaluation will be facilitated. Real-time guidance can also be used as a training tool for novice surgeons; however, factors such as financial investments, challenges in implementation, and a steep learning curve must be considered.