CLINICAL CASE OF ORBITAL EXOPROSTHESIS USING CAD / CAM TECHNOLOGIES

Abstract

Introduction. Today, the current problem of ophthalmology and maxillofacial surgery is the prosthesis of patients after exenteration of the orbit, as the end result should satisfy the patient in the first place. The process of orbital exoprosthesis is quite complex and requires an interdisciplinary approach involving a bio engineer, ophthalmologist, ophthalmologist and maxillofacial surgeon. The use of computer-aided design (CAD) / Computer-Aided Manufacturing (CAM) technologies makes prosthetics more accurate, predictable, fast, and significantly improves physician-patient collaboration. Aim. to present a clinical case of orbital exoprosthetics using computer CAD / CAM technologies Materials and methods: research analysis of modern scientific medical publications on this topic Results. Patient N., 33, turned to the maxillofacial surgeon with complaints of lack of the right eye, con stant feeling of depression and psychological discomfort when communicating with people. The patient covered the existing defect with a medical plaster or an occluder, wore image glasses. From the anamnesis it is known that at the age of 2 she was diagnosed with rhabdomyosarcoma and performed exenteration of the right orbit. Ophthalmic status OD: anophthalmos. Ophthalmic status of OS: without features, visual acuity - 1.0. Intraocular pressure (pneumotonometry) of the left eye - 15 mm Hg. Given the anamnesis, the significant role of the face in social adaptation, the aesthetic wishes of the patient, it was proposed to perform exoprosthetics of the orbit using CAD / CAM technology. The treatment was carried out in several stages: segmentation of computed tomography data and creation of virtual three-dimensional computer models; creation of design of patient-specific implants as a basis for fixing of an exoprosthesis; surgical intervention - fixation of patient-specific implants; manufacture of exoprosthesis. The postoperative period passed without complications. Six months after osseointegration of titanium implants, the manufactured exoprosthesis was placed in the bed and provided conditions for its permanent fixation. During the treat ment and long-term stages, no signs of inflammation around the implant elements, its rejection, allergic re actions to the material of the exoprosthesis or its toxic effect on the surrounding soft tissues were detected. Conclusions: Implementation of the approach using CAD / CAM technologies for orbital exoprosthesis in the presented patient allowed to virtually plan the stages of surgery, create a design and manufacture a patient-specific implant for fixing the exoprosthesis in complex clinical conditions. With the help of an acceptable aesthetic result of treatment it was possible to significantly improve the social adaptation of the patient.