{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T17:44:31Z","timestamp":1769622271667,"version":"3.49.0"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004837","name":"Spanish Ministry of Science and Innovation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004837","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["PI22\/00601"],"award-info":[{"award-number":["PI22\/00601"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Orbital dermoid cysts are common benign lesions; however, deep-seated or recurrent lesions near the orbital apex pose major surgical challenges due to their proximity to critical neurovascular structures. Lateral orbitotomy remains the reference approach, but accurate osteotomies and stable reconstruction can be difficult to achieve using conventional techniques. This study reports our initial experience using a fully digital, hospital-based point-of-care (POC) workflow to enhance precision and safety in complex orbital dermoid cyst surgery. Methods: We present a case series of three patients with orbital dermoid cysts treated at a tertiary center (2024\u20132025) using a comprehensive digital workflow. Preoperative assessment included CT and\/or MRI followed by virtual surgical planning (VSP) with orbit\u2013tumor segmentation and 3D modeling. Cutting guides and patient-specific implants (PSIs) were manufactured in-house under a certified hospital-based POC protocol. Surgical strategies were tailored to each lesion and included piezoelectric osteotomy, intraoperative navigation, intraoperative CT, and structured-light scanning when indicated. Results: Complete en bloc resection was achieved in all cases without capsular rupture or optic nerve injury. Intraoperative CT confirmed complete lesion removal and accurate PSI positioning and fitting. Structured-light scanning enabled radiation-free postoperative monitoring when used. All patients preserved full ocular motility, visual acuity, and facial symmetry, with no complications or recurrences during follow-up. Conclusions: The integration of VSP, in-house POC manufacturing, and image-guided surgery within a lateral orbitotomy approach provides a reproducible and fully integrated workflow. This strategy appears to improve surgical precision and safety while supporting optimal long-term functional and aesthetic outcomes in challenging orbital dermoid cyst cases.<\/jats:p>","DOI":"10.3390\/jcm15030937","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:21:40Z","timestamp":1769505700000},"page":"937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2216-9796","authenticated-orcid":false,"given":"Gonzalo","family":"Ruiz-de-Leon","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3329-4896","authenticated-orcid":false,"given":"Manuel","family":"Tousidonis","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"},{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Advanced Planning and 3D Manufacturing Unit (UPAM3D), Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Dr. Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose-Ignacio","family":"Salmeron","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"},{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben","family":"Perez-Ma\u00f1anes","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Advanced Planning and 3D Manufacturing Unit (UPAM3D), Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Dr. Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Alvarez-Mokthari","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6363-6888","authenticated-orcid":false,"given":"Marta","family":"Benito-Anguita","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borja","family":"Gonzalez-Moure","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Fernandez-Acosta","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susana","family":"Gomez de los Infantes-Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Advanced Planning and 3D Manufacturing Unit (UPAM3D), Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Dr. Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1355-4508","authenticated-orcid":false,"given":"Myriam","family":"Rodriguez-Rodriguez","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Advanced Planning and 3D Manufacturing Unit (UPAM3D), Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Dr. Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlota","family":"Ortiz-Garcia","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Advanced Planning and 3D Manufacturing Unit (UPAM3D), Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Dr. Esquerdo 46, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismael","family":"Nieva-Pascual","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Department of Ophthalmology, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar","family":"Cifuentes-Canorea","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Department of Ophthalmology, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose-Luis","family":"Urcelay","sequence":"additional","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"},{"name":"Department of Ophthalmology, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3576-6498","authenticated-orcid":false,"given":"Santiago","family":"Ochandiano","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Gregorio Mara\u00f1on University Hospital, 28007 Madrid, Spain"},{"name":"Gregorio Mara\u00f1\u00f3n Research Institute, 28007 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.survophthal.2004.02.001","article-title":"Orbital cysts of childhood: Classification, clinical features, and management","volume":"49","author":"Shields","year":"2004","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ben Simon, G., Greenberg, G., and Landau Prat, D. (2022). Cystic lesions of the orbit: Dermoid and epidermoid cysts. Atlas of Orbital Imaging, Springer.","DOI":"10.1007\/978-3-030-62426-2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1038\/sj.eye.6700045","article-title":"Clinical, radiological, and pathological examination of periocular dermoid cysts: Evidence of inflammation from an early age","volume":"16","author":"Rose","year":"2002","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/01676830.2019.1631357","article-title":"The spectrum of orbital dermoid cysts and their surgical management","volume":"39","author":"Bajric","year":"2020","journal-title":"Orbit"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/FOC-07\/11\/E11","article-title":"Orbital tumors treated using transcranial approaches: Surgical technique and neuro-ophthalmological results in 41 patients","volume":"23","author":"Margalit","year":"2007","journal-title":"Neurosurg. Focus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.otot.2008.07.002","article-title":"Surgical approaches to the orbit","volume":"19","author":"Humphrey","year":"2008","journal-title":"Oper. Tech. Otolaryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1001\/archotol.1993.01880140091014","article-title":"The coronal approach: Anatomic and technical considerations and morbidity","volume":"119","author":"Frodel","year":"1993","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105775","DOI":"10.1016\/j.oraloncology.2022.105775","article-title":"Projected cutting guides using an augmented reality system to improve surgical margins in maxillectomies: A preclinical study","volume":"127","author":"Chan","year":"2022","journal-title":"Oral Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Romano, A., Troise, S., Spinelli, R., Abbate, V., and Dell\u2019Aversana Orabona, G. (2025). Guided Frontal Sinus Osteotomy: A Pilot Study of a Digital Protocol for \u201cIn-House\u201d Manufacturing Surgical Cutting Guides. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093141"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s12663-017-1067-y","article-title":"A Cost-Effective, In-House, Positioning and Cutting Guide System for Orthognathic Surgery","volume":"17","author":"McAllister","year":"2018","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105976","DOI":"10.1016\/j.oraloncology.2022.105976","article-title":"The role of computer aided design\/computer assisted manufacturing (CAD\/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions","volume":"132","author":"Nyirjesy","year":"2022","journal-title":"Oral Oncol."},{"key":"ref_12","unstructured":"European Parliament and Council (2017). Regulation (EU) 2017\/745 on Medical Devices (MDR); EUR-Lex 2017, European Parliament and Council."},{"key":"ref_13","unstructured":"(2016). Medical Devices\u2014Quality Management Systems\u2014Requirements for Regulatory Purposes (Standard No. ISO 13485:2016)."},{"key":"ref_14","unstructured":"(2019). Medical Devices\u2014Application of Risk Management to Medical Devices (Standard No. ISO 14971:2019)."},{"key":"ref_15","unstructured":"(2018). Biological Evaluation of Medical Devices\u2014Part 1: Evaluation and Testing Within a Risk Management Process (Standard No. ISO 10993-1:2018)."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1055\/s-0040-1713941","article-title":"Surgical approaches to the orbit: A neurosurgical perspective","volume":"81","author":"Abussuud","year":"2020","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1055\/s-0040-1713904","article-title":"The lateral orbitotomy approach for intraorbital lesions","volume":"81","author":"Lee","year":"2020","journal-title":"J. Neurol. Surg. Part B Skull Base"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s11060-020-03516-6","article-title":"Ophthalmic and orbital considerations in the evaluation of skull base malignancies","volume":"150","author":"Karlin","year":"2020","journal-title":"J. Neurooncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.survophthal.2022.11.003","article-title":"The transconjunctival orbitotomy: A versatile approach to the orbit and beyond","volume":"68","author":"Mombaerts","year":"2023","journal-title":"Surv. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1055\/s-0040-1713849","article-title":"Transconjunctival and transcaruncular approaches to the orbit","volume":"81","author":"Wolkow","year":"2020","journal-title":"J. Neurol. Surg. Part B Skull Base"},{"key":"ref_21","unstructured":"American Academy of Ophthalmology (2025, August 16). Surgical Approaches to the Orbit. EyeWiki, Available online: https:\/\/eyewiki.org\/Surgical_Approaches_to_the_Orbit."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.ophtha.2012.07.089","article-title":"Endoscopic transcaruncular repair of large medial orbital wall fractures near the orbital apex","volume":"120","author":"Wu","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, X., Hua, W., Quan, K., Yu, G., Du, Z., Yang, Z., Wang, X., Song, J., Chen, L., and Zhu, W. (2022). Endoscopic Endonasal Intraconal Approach for Orbital Tumor Resection: Case Series and Systematic Review. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.780551"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.20517\/2347-9264.2022.106","article-title":"Operative technique for a combined transcaruncular\u2013transconjunctival approach to double-walled orbital fractures","volume":"10","author":"Soliman","year":"2023","journal-title":"Plast. Aesthet. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/j.ophtha.2024.05.014","article-title":"Intraoperative image guidance in orbital and lacrimal surgery: A report by the American Academy of Ophthalmology","volume":"131","author":"McCulley","year":"2024","journal-title":"Ophthalmology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1080\/01676830.2024.2343299","article-title":"Image-guided navigation in posterior orbital tumour surgery: A comparative cohort study","volume":"43","author":"Khan","year":"2024","journal-title":"Orbit"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/1943387520904869","article-title":"Intraoperative Navigation and Cone Beam Computed Tomography for Restoring Orbital Dimensions: A Single-Center Experience","volume":"13","author":"Abeloos","year":"2020","journal-title":"Craniomaxillofac. Trauma Reconstr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s10006-022-01074-x","article-title":"Orbital reconstruction: A systematic review and meta-analysis evaluating the role of patient-specific implants","volume":"27","author":"Kotecha","year":"2023","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Singh, A.K., Khanal, N., Chaulagain, R., Sharma, N., and Thieringer, F.M. (2023). Is the pre-shaping of an orbital implant on a patient-specific 3D-printed model advantageous compared to conventional free-hand shaping? A systematic review and meta-analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12103426"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Consorti, G., Monarchi, G., and Catarzi, L. (2024). Presurgical virtual planning and intraoperative navigation with 3D-preformed mesh: A new protocol for primary orbital fracture reconstruction. Life, 14.","DOI":"10.3390\/life14040482"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Major, M., M\u00e9sz\u00e1ros, B., W\u00fcrsching, T., Poly\u00e1k, M., Kammerhofer, G., N\u00e9meth, Z., Szab\u00f3, G., and Nagy, K. (2024). Evaluation of a structured light scanner for 3D facial imaging: A comparative study with direct anthropometry. Sensors, 24.","DOI":"10.3390\/s24165286"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"8172","DOI":"10.1038\/s41598-024-57370-x","article-title":"Reliability and validity of handheld structured light scanners and a static stereophotogrammetry system in facial 3D imaging","volume":"14","author":"Schipper","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_33","first-page":"158","article-title":"Piezosurgery as a further technical adjunct in minimally invasive supraorbital keyhole approach and lateral orbitotomy","volume":"76","author":"Iacoangeli","year":"2015","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/IOP.0b013e3181b8e614","article-title":"Ultrasonic bone removal versus high-speed burring for lateral orbital decompression in thyroid eye disease","volume":"26","author":"Cho","year":"2010","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_35","first-page":"9478512","article-title":"Deep lateral wall partial rim-sparing orbital decompression with ultrasonic bone removal for thyroid-related orbitopathy","volume":"2019","year":"2019","journal-title":"J. Ophthalmol."},{"key":"ref_36","unstructured":"European Commission (2023). MDCG 2021-1 Rev.1. Application of Article 5(5)\u2014Health Institution Exemption, European Commission."},{"key":"ref_37","unstructured":"(2006). Sterilization of Health Care Products\u2014Moist Heat\u2014Part 1 (Standard No. ISO 17665-1:2006)."},{"key":"ref_38","unstructured":"(2019). Packaging for Terminally Sterilized Medical Devices (Standard No. ISO 11607-1\/-2:2019)."},{"key":"ref_39","unstructured":"International Commission on Radiological Protection (2007). The 2007 recommendations of the International Commission on Radiological Protection. Ann. ICRP, 37, 1\u2013332."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.3346\/jkms.2016.31.S1.S6","article-title":"General principles of radiation protection in fields of diagnostic medical exposure","volume":"31","author":"Do","year":"2016","journal-title":"J. Korean Med. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jormas.2017.07.002","article-title":"How useful is 3D printing in maxillofacial surgery?","volume":"118","author":"Louvrier","year":"2017","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Sigron, G.R., R\u00fcedi, N., Chammartin, F., Meyer, S., Msallem, B., Kunz, C., and Thieringer, F.M. (2020). Three-dimensional analysis of isolated orbital floor fractures pre- and post-reconstruction with standard titanium meshes and hybrid patient-specific implants. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051579"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.fsc.2022.01.003","article-title":"Three-dimensional anthropometric facial imaging\u2014A comparison of different 3D scanners","volume":"30","author":"Koban","year":"2022","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.bjps.2020.08.050","article-title":"Three-dimensional scanners for soft-tissue facial assessment in clinical practice","volume":"74","author":"Petrides","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/937\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T05:15:42Z","timestamp":1769577342000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15030937"],"URL":"https:\/\/doi.org\/10.3390\/jcm15030937","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}