Patient-Specific Mirrored Planning Leads to Superior Symmetry for Late Post-Traumatic Deformity After Orbital Zygomatic Maxillary Complex Fractures

Background: Post-traumatic orbital-ZMC deformity is notoriously difficult to correct because of soft tissue contraction and loss of anatomic landmarks. To see whether virtual planning is beneficial, we studied orbital/malar volume correction, globe position, malar projection and patient satisfaction. Methods: Patients were divided into 2 equal groups: 1) traditional intraoperative repositioning (‘eyeball test’); 2) virtual mirrored-image planning over a 12-year period (n=32). Outcomes were compared using 1) orbital volume, 2) globe position, 3) malar projection, 4) malar soft-tissue volume; and 5) PROMIS surveys. Results: Groups were comparable: age (38.2 ± 5 years vs 36.8 ± 4 years), mechanism of injury (fall/motor vehicle collision/assault: 35/28/37% vs 31/33/36%), time from injury to reconstruction (4.2 ± 3 years vs 3.8 ± 2 years), follow-up duration (13.1 ± 4 months vs 12.7 ± 2 months). Orbital volume: The traditional group had greater variability in postoperative orbital volume (26.1cc ± 5.1 vs 25.5cc ± 1.7) and globe position. Malar projection: Postoperative deviation from the ideal malar coordinate was lower with VSP, indicating greater accuracy (1.6 mm ± 0.4 vs 4.3 mm ± 3.1). Malar Volume: Both groups improved, but VSP demonstrated lower variability and greater predictability (102.2 cc ± 2.8 vs 98.2 cc ± 8.1). PROMIS scores were superior with VSP, including Anxiety (56 ± 2.4 vs. 61 ± 2.8) and Depression (54 ± 2.2 vs. 59 ± 2.3). Conclusions: For post-traumatic ZMC/ orbital deformity, virtual mirrored-image planning is superior to traditional visual estimation technique regarding symmetry, globe position, malar projection and psychosocial scores.