Reconstruction of an orbital fracture in a mare using a 3D-printed patient-specific implant.
Authors: Gernhardt Jennifer, Böttcher Peter, Eule J Corinna, Mählmann Kathrin, Müller Eva, Lischer Christoph J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary A 25-year-old Haflinger mare presenting with severe periocular swelling and emphysema caused by a complex orbital fracture communicating with the caudal maxillary sinus underwent novel surgical reconstruction using a patient-specific implant (PSI) designed from CT imaging data. The surgical team converted the mare's computed tomographic images into an STL file and 3D-printed a polylactic acid implant that precisely replicated the horse's normal orbital anatomy, then secured it via a concho-frontal sinus flap approach using titanium locking screws and non-absorbable transosseous sutures, with the implant lined with porcine small intestinal submucosa to facilitate integration. Post-operative recovery was rapid—emphysema resolved immediately and ocular function remained unrestricted—though a minor subcutaneous infection adjacent to the fixation site developed and resolved with conservative management; follow-up imaging at 11 weeks and owner observations at 18 months revealed complete healing with excellent cosmetic and functional outcomes aside from minimal residual ptosis. This case demonstrates that PSIs offer a precision solution for equine orbital fractures previously considered challenging or cosmetically compromised by conventional repair techniques, potentially reducing post-operative complications and improving functional outcomes compared to traditional plating or packing methods. For practitioners managing horses with complex facial trauma, this technology warrants consideration as referral practices develop access to such bespoke surgical solutions, though the cost-benefit analysis and long-term durability of PLA implants in the equine environment require further investigation across additional cases.
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Practical Takeaways
- •Patient-specific 3D-printed implants offer a viable surgical option for complex orbital fractures in horses when standard repair techniques may be inadequate
- •This technology enables precise reconstruction of complex anatomy, potentially improving cosmetic and functional outcomes in orbital trauma cases
- •While this case showed good results, the technique requires CT imaging, 3D design capability, and specialized surgical expertise—currently available only at referral centers
Key Findings
- •A 3D-printed patient-specific implant (PSI) made from polylactic acid successfully reconstructed a complex orbital fracture communicating with the caudal maxillary sinus in a 25-year-old mare
- •Emphysema resolved postoperatively and ocular function remained unrestricted at 18-month follow-up with only minimal residual upper eyelid ptosis
- •Surgical approach combined concho-frontal sinus flap with sinoscopy and PSI secured with titanium screws and transosseous fiber loops