Background and objectives : Several attempts were reported in the literature regarding the use of computer-assisted techniques in reconstruction of orbitozygomatic fractures. The costs of such techniques may limit their use in routine practice, except if they offer higher accuracy and significant improvement in clinical outcomes. Therefore a comparison of the “free-hand” and “computer-assisted” techniques for repair of orbitozygomatic fractures was necessary.
Methods : Ten patients with unilaterally displaced orbitozygomatic fractures were divided into two equal groups: Group I: Received a computer-assisted reconstruction. Group II: Received a conventional “free-hand” reconstruction. Group I received corrected stereolithographic orbital models and zygomatic templates. Titanium meshes were bent onto the models preoperatively, while the templates were used intraoperatively for guidance of zygomatic reduction into the pre-planned position. In group II bending of the titanium meshes was carried out intraoperatively and “free-hand” reduction of the zygomatic complex was accomplished. Pre- and postoperative CT based volumetric assessment of the intact, traumatized and reconstructed orbits were executed. In addition, CT based linear measurement of the degree of enophthalmous was done pre- and postoperatively.
Results : Calculations of the reconstructed versus the intact orbital volumes showed a reconstruction accuracy of 97.9 + 5.03% for group I (i.e. a mean of 2.1% of overcorrection) while group II showed an accuracy of 101.7 + 5.38% (i.e. a mean of 1.71% of undercorrection). There was no statistically significant difference between the accuracy of both techniques in restoring the orbital volume ( p = 0.28). Similarly, there were no statistically significant differences between both groups regarding their pre-and postoperative degrees of enophthalmous ( p = 0.773 and 0.477 respectively).
Conclusion : Free-hand orbitozygomatic reconstruction appears to be a valid technique among other attractive emerging techniques. Computer-assisted reconstruction could be helpful in cases with massive internal orbital disruption and in delayed cases when some degree of bone resorption hinders anatomical reduction.