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Three-dimensional (3D) printing for post-traumatic orbital reconstruction, a systematic review and meta-analysis

  • Alexander Murray-Douglass
    Correspondence
    Corresponding author at: Faculty of Medicine, The University of Queensland, The Royal Brisbane and Women’s Hospital, Mayne Medical Reception Level 2, Mayne Medical Building, 288 Herston Road, Herston, QLD 4006, Australia.
    Affiliations
    Faculty of Medicine, The University of Queensland, Australia

    Royal Brisbane and Women’s Hospital, Australia
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  • Centaine Snoswell
    Affiliations
    Centre for Health Services Research, The University of Queensland, Australia

    Centre for Online Health, The University of Queensland, Australia

    Department of Pharmacy, Princess Alexandra Hospital, Australia
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  • Craig Winter
    Affiliations
    Neurosurgery, Royal Brisbane and Women’s Hospital, Australia

    Faculty of Medicine, The University of Queensland, Australia
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  • Richard Harris
    Affiliations
    Oral and Maxillofacial Surgery, Royal Brisbane and Women’s Hospital, Australia

    Faculty of Medicine, The University of Queensland, Australia
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      Abstract

      The purpose of this study was to determine if three-dimensional (3D) printed orbit models and preoperative plate contouring provides benefit over traditional surgical reconstruction of orbit fractures. This systematic review and meta-analysis searched five databases to identify cases of 3D printing for orbital fracture reconstruction. Primary outcomes were resolution of diplopia and enophthalmos, orbital volume symmetry and operation duration. Meta-analyses were used to calculate log odds ratios (OR) for diplopia and enophthalmos and absolute mean difference for orbital volume. A total of 58 articles describing 906 patient cases were included. A single article for each of diplopia and enophthalmos compared 3D printing with traditional management, which prevented answering the primary research question. However, pre-post meta-analysis showed that postoperative groups were less likely to have diplopia (n = 747, log OR = −2.35, 95%CI −1.72 to −2.98, p < 0.001, I2 = 10.91%) and enophthalmos (n = 486, log OR = −2.47, 95%CI −1.95 to −2.99, p < 0.001, I2 = 11.33%) than preoperatively. Mean orbital volume did not differ between the repaired and uninjured orbits (n = 290, mean difference = −0.13 cm3, 95%CI −0.48 to 0.22, p = 0.472, I2 = 9.48%). Pooled mean operation duration for orbital reconstruction with 3D printing was 67.70 minutes (standard error [SE] = 4.24 minutes). Orbital reconstruction combined with 3D printing adequately restores orbital volume symmetry and improves diplopia and enophthalmos. Due to a lack of controlled studies, it remains unclear what contribution 3D printing alone makes to these results. Three-dimensional printing is likely a safe, accurate and effective adjunct; however, further controlled studies are required.

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