Revolutionizing Reconstruction: The Role of Custom Implants in Orbital and Zygomatic Complex Fractures

Introduction: In the realm of orbital reconstruction following traumatic fractures involving the zygomatic complex (ZMC), the adoption of patient-specific implants (PSI) crafted through computer-assisted technology prompts inquiry into its comparative efficacy against conventional methods. This study investigates whether PSI enhances outcomes—such as orbital volume, enophthalmos, diplopia, implant malposition, and ZMC symmetry—in adult patients, compared to conventional approaches. Methods: We conducted a systematic review following PRISMA guidelines, focusing on peer-reviewed articles published after 2014 that reported comparisons between implants based on computer-assisted technology and conventional methods for orbital bone and zygomatic complex fractures in adults. Databases and trial registries were systematically searched to identify relevant studies. The Newcastle-Ottawa Scale (NOS) was employed to assess the quality of studies included in this systematic review. Results: Following a comprehensive literature search, 1,463 articles were initially identified and screened for relevance and duplication, resulting in a final selection of 3 articles. Orbital and zygomatic complex reconstruction using patient-specific implants (PSI) was performed in 61 patients, while 70 patients underwent conventional methods. The most common post-surgical complications included enophthalmos (n=23), diplopia (n=20), and implant malposition (n=13). PSI facilitated the restoration of orbital volume levels between injured and uninjured orbital bones and achieved ZMC symmetry. All studies included in this review were categorized as level 3 evidence. Conclusion: This examination of published literature on PSI for orbital and ZMC fracture reconstruction underscores that, while PSI can effectively, precisely, and safely address orbital fractures, patient outcomes are largely comparable to those achieved with conventional methods, and PSI do not present a clear advantage over conventional implants.