# Advanced Digital Workflow for Lateral Orbitotomy in Orbital Dermoid Cysts: Integration of Point-of-Care Manufacturing and Intraoperative Navigation

## TL;DR

A new digital workflow using in-house manufacturing and navigation improves precision and safety in complex orbital cyst surgery.

## Contribution

Integration of point-of-care manufacturing and intraoperative navigation in lateral orbitotomy for orbital dermoid cysts.

## Key findings

- Complete en bloc resection was achieved in all three cases without optic nerve injury or capsular rupture.
- Intraoperative CT confirmed accurate positioning and fitting of patient-specific implants.
- Structured-light scanning enabled radiation-free postoperative monitoring with preserved ocular motility and facial symmetry.

## Abstract

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 (2024–2025) using a comprehensive digital workflow. Preoperative assessment included CT and/or MRI followed by virtual surgical planning (VSP) with orbit–tumor 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.