Low-cost 3D-printed surgical guide for orbital floor reconstruction

Orbital floor fracture management often requires surgical repair of the orbital floor, using the placement of an implant on top of the fracture to restore orbital volume and resolve complications. Repair is typically done using custom implants premade prior to surgery, or with standard implants cut to size intraoperatively. Placement of standard plates can often rely on clinical judgement due to the lack of landmarks, contributing to an increased complication risk. Here we propose a 3D printed prototype to guide orbital floor implant placement. The device was created from a scan of a patient skull model, designed using computer aided design (CAD), and 3D printed. Fit testing was performed on fifteen of random patient skull models between the ages of 17 - 54, with 67% female and 33% male to ensure adequate fit across ages and genders. The extent of the fit was quantified using a rubric. Fit testing showed consistency across varying skull anatomy with slight variation. For the left orbit, the mean fit score, out of 4, was 3.47 ± 0.64; for the right orbit, it was 3.87 ± 0.35. Both sides had a median score of 4. The proposed prototype showed reasonable preliminary efficacy in orbital rim fit and ability to guide implant placement. Further studies with cadaver models and within operations are indicated to further evaluate the prototype’s effectiveness and quantify its effect in reducing implant misplacement related complications.