Secondary Orbital Reconstruction in Patients with Prior Orbital Fracture Repair

Purpose. To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings. Methods. A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients’ demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed. Results. All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm (P<0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured. Conclusions. This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.

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Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520939032 ◽

2020 ◽

pp. 194338752093903

Author(s):

Sophia Seen ◽

Stephanie Young ◽

Stephanie S. Lang ◽

Thiam-Chye Lim ◽

Shantha Amrith ◽

...

Keyword(s):

Clinical Findings ◽

Fracture Repair ◽

Titanium Implants ◽

Medial Wall ◽

P Value ◽

Orbital Fracture ◽

Ocular Motility ◽

Orbital Reconstruction ◽

Alloplastic Materials ◽

Materials Used

Study Design: Retrospective comparative interventional series of all patients who had undergone orbital fracture repair by 2 senior orbital surgeons in a single tertiary trauma center from January 2005 to December 2014. Objective: To compare the outcomes of different implants used for various types of orbital fractures. Methods: Patients were evaluated by age, gender, etiology of fracture, clinical findings, type of fractures, and implant used. Main outcome measures included restoration of premorbid state without morbidity and complications including enophthalmos, diplopia, infraorbital hypoesthesia, and ocular motility restriction 1 year after fracture repair. Implant-related complications were collected for analysis. Results: There were a total of 274 patients with 307 orbits reconstructed. Thirty-three (12.0%) patients sustained bilateral injuries; 58.0% ( n = 178) of orbits had simple fractures (isolated orbital floor, medial wall, or combined floor and medial wall). The distribution of implants used were bioresorbable ( n = 117, 38.1%) and prefabricated titanium plates ( n = 98, 31.9%) depending upon the nature of fracture. Bioresorbables, titanium plate, and porous polyethylene were used significantly more than titanium mesh for simple fractures, and prefabricated anatomic titanium implants were used significantly more than the other implants for complex fractures. There was a statistically significant improvement in diplopia, enophthalmos, ocular motility, and infraorbital hypoesthesia ( p-value < 0.001) 1 year following orbital fracture reconstruction. Conclusions: When used appropriately, diverse alloplastic materials used in orbital fracture repair tailored to the indication aid orbital reconstruction outcomes with each material having its own unique characteristics.

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