{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:55:02Z","timestamp":1781708102036,"version":"3.54.5"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Helsinki including Helsinki University Central Hospital"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Oral Maxillofac Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>We present our experience of titanium-milled two-piece patient-specific implants (PSIs) for primary reconstructions of extensive orbital floor and medial wall fractures (EOFMFs) and evaluate their postoperative functional and aesthetic outcomes in relation to commercially available implants.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We included all patients with primary reconstructions (&lt;\u200922\u00a0days from injury) of EOFMFs treated in our department between January 2011 and October 2020. Extensive orbital floor and medial wall fracture was defined as involvement of orbital floor, medial wall and maxilloethmoidal junction; a fracture defect 5\u00a0mm or more; defect size more than a third of both inferior and medial walls; and Jaqui\u00e9ry classification III or more. Patient characteristics, details of fracture defects and surgeries, postoperative outcomes and implant positions were retrospectively evaluated and compared between study groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Nineteen patients were included: 5 with two-piece PSIs and 14 with commercial implants. Implant position was good in 4\/5 patients with two-piece PSIs and 2\/14 with commercial implants. Revision surgery, globe malposition (GMP)\u2009&gt;\u20092\u00a0mm, significant diplopia and poor implant position were more frequent in patients with commercial implants than two-piece PSIs. None of the patients with a good overall implant position had any significant postoperative symptoms.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Extensive orbital fracture reconstructions are somewhat rare, and surgical treatment is associated with a high rate of complications and postoperative symptoms. Titanium-milled two-piece PSIs are well suited for primary reconstructions of EOFMFs, as they lead to more precise reconstructions and fewer postoperative symptoms than commercially available implants.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10006-022-01065-y","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T20:03:36Z","timestamp":1652904216000},"page":"333-340","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Primary reconstruction of extensive orbital fractures using two-piece patient-specific implants: the Helsinki protocol"],"prefix":"10.1007","volume":"27","author":[{"given":"Malla I.","family":"Salli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Nikunen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Sn\u00e4ll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"issue":"2","key":"1065_CR1","doi-asserted-by":"publisher","first-page":"138","DOI":"10.4103\/0974-9233.63076","volume":"17","author":"MO Gonzalez","year":"2010","unstructured":"Gonzalez MO, Durairaj VD (2010) Indirect orbital floor fractures: a meta-analysis. 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The Internal Review Board of the Head and Neck Centre waived the requirement of informed consent due to the retrospective nature of this study. The guidelines of the Declaration of Helsinki were followed in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Patient consent was not required because of the retrospective nature of the study. Consent has been obtained from the patient cases presented in patient\/computer tomography images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The patients\u2019 anonymity has not been endangered in this study. However, informed consent was obtained from all individual participants who could be theoretically identified from the images.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}