الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This study was conducted clinically and radiographically to compare the use of computer –assisted individualized titanium mesh prepared by rapid prototyping stereo-lithography model and the conventional titanium mesh for reconstruction of fractures orbital walls and their efficacy on correction the complications resulting from fractures like diplopia, enophthalmos, restriction of the movement of the ocular muscles and infra orbital nerve disturbances.
Twenty patients suffering from unilateral orbital fractures either isolated or combined with other facial fractures that require reconstruction participated in this study and they were equally divided into two groups, study and control groups.
group 1: (Study group) 10 patients underwent orbital reconstruction using the computer-assisted fabricated individualized titanium mesh
group 2: (Control group) 10 patient underwent orbital reconstruction using conventional titanium mesh.
All patients were evaluated pre and post- operatively clinically and radiographically.
All patients were subjected to full clinical examination by inspection and palpation of the fracture sites to detect the presence of edema, ecchymosis, soft tissue laceration, areas of tenderness, step deformities, mobility of the fractured segments and ocular mobility. Complete ophthalmological evaluations were performed to detect visual disturbances, enophthlamos, diplopia, and restriction of the ocular movement .Nerve-sensory evaluation of the infraorbital nerve was performed to evaluate its function.
Radiographic examination was accomplished for all patients. 1mm cuts, axial, coronal, sagittal and 3D reconstruction computerized tomography was taken for all patients that evaluated the site of fractures, the orbital volume, and the degree of enophthalmos and compared them before and after reconstruction.
All procedures for group 1: (study group) and group 2: (control group) were performed under general anesthesia and strict aseptic conditions in the theater. The approach to the fracture site depended upon the type of injury. The computer- assisted titanium mesh was used for group 1 (study group) and conventional titanium mesh was used for group 2 (control group). The wounds were closed in layers (periosteum, muscle and skin).
All patients were examined at the 1st week postoperatively to evaluate the degree of edema, presence of infection, degree of pain, stability of fractured segment, presence of abnormal sensation, and any other clinical findings. Ophthalmological evaluations were performed at the 1st week and 6 months postoperatively. Pin prick test and electrical pulp testing were performed at 1st month and 6 months postoperatively to evaluate the recovery of the infra-orbital nerve.
Clinically and radiographically the study group showed better results than the control group. Precise reconstruction of the orbital volumes and the internal orbital anatomy by the individualized titanium mesh correlated the enophthalamos correction, improved the clinical outcomes concerning diplopia, restriction of the ocular movement and hypoesthesia of infraorbital nerve and also improved esthetic outcome.
The results of this study accomplished that, virtual surgical planning and computer- assisted individualized titanium mesh fabricated based on stereo-lithography rapid prototyping model was completely met the requirements of orbital reconstruction though it was costly.