Methodology for the prevention of complications in bone orbit decompression: individual surgical cutting guides

Abstract

Objective: According to the literature, the frequency of complications of surgical decompression of the orbit is from 9.3% to 35% (most often - the appearance of secondary diplopia, less often - lesions of the suborbital nerve, bleeding in the orbit, etc). Therefore, the development of ways to prevent complications during bone decompression of the orbit is an actual task of endocrine orbitopathy (EOP) management. Development of a methodology for the prevention of complications in bone orbit decompression in patients with endocrine orbitopathy, based on the use of individual surgical cutting guides. Methods: We analyzed the results of EOP treatment between 17 patients, who underwent bone orbital decompression at the Kyiv Regional Clinical Hospital in the period from 2017 to 2021. The rate of post-surgical complications, as well as exophthalmos severity were evaluated. Digital modeling and subsequent production of surgical guides was performed using Disior orbital software, D2P software and Geomatic Freeform Plus. Results: When performing surgical decompression of the orbit, it is important to "bypass" the following anatomical structures of the orbit: buttresses (places that will serve as a support for the eyeball), attachment of the oculomotor muscles, suborbital nerve canal (to prevent hyposthesia of the II branch of the trigeminal nerve). Conclusion: Surgical decompression of the orbit with the use of surgical guides can achieve a significant reduction in the degree of exophthalmos and reduce the risk of postoperative complications due to damage to the oculomotor muscles and the suborbital nerve.