Computer-aided vs. conventional planning in orbital traumatology using preformed meshes – development of a new workflow

Purpose Preformed orbital meshes (POMs) are routinely used in orbital traumatology. As the shapes of commercially available POMs differ, we wanted to evaluate whether investigators would use the same POM in a given situation and perform similar virtual positioning. Furthermore, we investigated whether these tasks could be performed more quickly and more reproducibly using a new software workflow. Materials and Methods Four investigators performed virtual planning of orbital fracture treatment in the Brainlab system (Brainlab, Munich, Germany) using 3 different POMs. Time effort, POM selection, minimum-maximum deviations, and fitting within a distance corridor were measured and compared with the new software workflow. Results Regarding time effort, a distinct learning curve was seen. An average of 15 minutes was needed, which compared inferiorly with 1 minute using the software algorithm. In POM selection, the individual choice of the investigators differed to a large extent. An identical POM was chosen in only 3 of 10 cases, and in 2 of 10 cases, all investigators and software choices were identical. Manual POM planning showed constant collision between bone and mesh with large interindividual maximum deviations. By defining collision prevention and achieving the highest concordance between bone and mesh geometry within a given distance slot, the new software was able to select and place the best-fitting POM and display regions of potential necessary presurgical modifications. Conclusions Planning of orbital fracture treatment in a navigation system using POMs seems highly individual. Integrating new software workflows should reduce time effort and lead to reproducible planning results, which could be used in intraoperative navigation. Furthermore, our new workflow could be used for training and expanded to other anatomic regions.