The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review

The aim of this study is to present a narrative review of the properties of materials currently used for orbital floor reconstruction. Orbital floor fractures, due to their complex anatomy, physiology, and aesthetic concerns, pose complexities regarding management. Since the 1950s, a myriad of materials has been used to reconstruct orbital floor fractures. This narrative review synthesises the findings of literature retrieved from search of PubMed, Web of Science, and Google Scholar databases. This narrative review was conducted of 66 studies on reconstructive materials. Ideal material properties are that they are resorbable, osteoconductive, resistant to infection, minimally reactive, do not induce capsule formation, allow for bony ingrowth, are cheap, and readily available. Autologous implants provide reliable, lifelong, and biocompatible material choices. Allogenic materials pose a threat of catastrophic disease transmission. Newer alloplastic materials have gained popularity. Consideration must be made when deliberating the use of permanent alloplastic materials that are a foreign body with potential body interactions, or the use of resorbable alloplastic materials failing to provide adequate support for orbital contents. It is vital that surgeons have an appropriate knowledge of materials so that they are used appropriately and reduce the risks of complications.

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Surgical Approach to Orbital Floor Fractures: Comparing Complication Rates Between Subciliary and Subconjunctival Approaches

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520904893 ◽

2020 ◽

Vol 13 (1) ◽

pp. 45-48

Author(s):

Joel A. Bronstein ◽

William J. Bruce ◽

Fadi Bakhos ◽

Dalia Ishaq ◽

Cara J. Joyce ◽

...

Keyword(s):

Surgical Approach ◽

Complication Rate ◽

Patient Characteristics ◽

Orbital Floor ◽

Study Patient ◽

Complication Rates ◽

Postoperative Complication Rate ◽

Corneal Injury ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction

Background: There are multiple approaches to repairing orbital floor fractures. This study compares the postoperative complications of the subciliary and transconjunctival approaches. Methods: The electronic medical records from 2 hospitals were screened for CPT codes associated with orbital floor reconstruction. A total of 184 patients were identified and included in the study. Patient characteristics and complications were compared by surgical approach. Results: Of the 184 patients, 82 (44.6%) were in the subciliary group and 102 (55.4%) were in the transconjunctival group. The overall postoperative complication rate was 25.5%. The most common of these were diplopia (11.4%), corneal injury (7.1%), proptosis (5.4%), and enopthalmos (4.9%). The complication rate was not statistically significant between the 2 groups. Conclusion: Subciliary and transconjunctival approaches to orbital floor repair are equally safe. This study is limited by a smaller sample size, and a larger study will likely be necessary to fully address this question.

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Blowout Fracture in a 3-Year-Old

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0033-1333880 ◽

2013 ◽

Vol 6 (2) ◽

pp. 133-136 ◽

Cited By ~ 1

Author(s):

Britt I. Pluijmers ◽

Maarten J. Koudstaal ◽

Dion Paridaens ◽

Karel G.H. van der Wal

Keyword(s):

Young Children ◽

Surgical Planning ◽

Clinical Symptoms ◽

Orbital Floor ◽

Conservative Approach ◽

Transconjunctival Approach ◽

Blowout Fracture ◽

Fractures In Children ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction

A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed through a transconjunctival approach. This case highlights the rarity of pure blowout fractures in young children. The specific presentation and diagnostics of orbital floor fractures in children and the related surgical planning and intervention are discussed.

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ORBITAL FLOOR RECONSTRUCTION WITH TRANS-ANTRAL APPROACH USING ENDOSCOPE

UNIVERSITY JOURNAL OF DENTAL SCIENCES ◽

10.21276/ujds.2020.6.1.10 ◽

2020 ◽

Vol 6 (1) ◽

pp. 40-42

Author(s):

RISHABH GIRI ◽

Vikas Kunwar Singh ◽

Ruchika Tiwari ◽

Gaurang Thanvi

Keyword(s):

Posterior Part ◽

Good Alternative ◽

Conventional Approach ◽

Orbital Floor ◽

Treatment Modalities ◽

Orbital Fractures ◽

Blowout Fracture ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Endoscopic Assistance

Background and objective: Orbital floor fractures are very common in current day to day scenario. Till date different treatment modalities have been tried to reconstruct the orbital fractures. Conventionally various transorbital approaches have been used. But in cases where there is involvement of posterior part of orbit there is drawback of incomplete accessibility. To overcome this endoscopic assistance tends to get mandatory through trans-antral approach for better visualization, providing a good alternative to conventional approach. Case Report: A 55-year-old male patient with pure blowout fracture along with persistent diplopia and enophthalmos was operated with sub tarsal approach along with trans antral approach using endoscope. Result: The post-surgical results were satisfactory in respect to correction of diplopia and enophthalmos. Conclusion: Conventional approach assisted with endoscope provides a new method of managing Orbital floor fractures improving treatment outcomes.

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ORBITAL FLOOR RECONSTRUCTION WITH TITANIUM MESH;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2152 ◽

2014 ◽

Vol 21 (03) ◽

pp. 575-579

Author(s):

Muhammad Usman Khalid ◽

Arshad Mahmood Malik ◽

Omer Sefvan Janjua

Keyword(s):

Study Design ◽

Complication Rate ◽

Maxillofacial Surgery ◽

Male Gender ◽

Orbital Floor ◽

Titanium Mesh ◽

No Donor ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Infraorbital Rim

Objective: To determine the outcome of orbital floor reconstruction with titaniummesh in terms of diplopia, enophthalmos, dystopia and infection etc. Study design: Descriptivecase series. Place & duration of study: Department of Oral & Maxillofacial Surgery, PunjabMedical College / Allied Hospital Faisalabad. One and Half year from 01-10-12 to 31-03-14.Material and Method: Twenty two patients clinically and radiographically having defect in theorbital floor due to trauma were included in the study. Titanium mesh was used to reconstruct theorbital floor through infraorbital rim incision and secured in place with 5mm micro screws. Thevariables to be analyzed were diplopia, enophthalmos, orbital dystopia and infection. Results: Inour study male gender predominates over female 20/22. Mean age of patients is 29.36 years ±5.21. Diplopia persisted in 2/10 (20%) patients. Enophthalmos persisted in 7/18 (38.8%) patients.dystopia persisted in ¼ (25%) patients. Infection didn’t develop in any of our patient (0%). Visualacuity was not affected in any of the patient (0%). Conclusions: Titanium mesh is a suitablematerial for reconstruction of orbital floor fractures with little complication rate and no donor sitemorbidity.

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Teflon prosthesis in orbital floor fracture

Canadian Journal of Plastic Surgery ◽

10.1177/229255039400200110 ◽

1994 ◽

Vol 2 (1) ◽

pp. 32-34 ◽

Cited By ~ 1

Author(s):

Patrick G Harris ◽

Roger-Paul Delorme ◽

Roland Charbonneau ◽

Hugo Ciaburro ◽

Gilles Frenette

Keyword(s):

Operative Time ◽

Orbital Floor ◽

Operative Morbidity ◽

Recommended Treatment ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Primary Bone ◽

The Mean ◽

Panfacial Fractures ◽

Zygomatic Fractures

Primary bone grafting is the recommended treatment for orbital floor fractures with bone defects, but this technique has a greater operative morbidity than the simpler use of the Teflon prosthesis. This study evaluates the use of the Teflon prosthesis. In 9 years, 110 patients with 115 orbital floor fractures were treated with Teflon prostheses. Of those, 90 patients had only orbital floor or orbito-zygomatic fractures and 20 had panfacial fractures. The mean operative time was 87 mins. Seventy-seven patients had good results. Complications included diplopia, ectropion, enophthalmia and palpable prosthesis. Seven prostheses required removal between three and 11 months postoperatively. No prosthesis became infected. Orbital floor reconstruction with a Teflon prosthesis is a relatively simple and short procedure associated with a low morbidity, giving good results except in cases of severe floor defects.

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Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model

Plastic Surgery ◽

10.1177/2292550317702370 ◽

2017 ◽

Vol 25 (3) ◽

pp. 163-170 ◽

Cited By ~ 1

Author(s):

Ali Mubin Aral ◽

Selahattin Özmen ◽

Safak Uygur ◽

Basar Kaya ◽

Neslihan Coskun ◽

...

Keyword(s):

Bone Formation ◽

Orbital Floor ◽

Histological Evaluation ◽

Porous Polyethylene ◽

Alloplastic Materials ◽

Orbital Floor Fractures ◽

Significant Difference ◽

Defect Creation ◽

Group 3

Background: Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models. Objective: Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model. Methods: Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6. Results: No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups. Conclusion: Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects.

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Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

FACE ◽

10.1177/27325016211001939 ◽

2021 ◽

pp. 273250162110019

Author(s):

Eva Niklinska ◽

Matthew E. Pontell ◽

Nolan Jaeger ◽

Michael Golinko ◽

Kevin Kelly

Keyword(s):

Average Length ◽

Skeletal Maturity ◽

Donor Site ◽

Retrospective Chart Review ◽

Orbital Floor ◽

Facial Skeleton ◽

Orbital Reconstruction ◽

Graft Harvest ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction

Background: Orbital floor fractures constitute roughly 20% of all pediatric facial fractures. Reconstructive techniques are broadly subdivided into alloplastic and autologous. While pediatric literature exists for alloplastic orbital reconstruction, autologous orbital reconstruction studies are limited. Here we present several cases of posttraumatic pediatric orbital reconstruction utilizing autologous split rib graft. Methods: After IRB approval, a retrospective chart review was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt from 2003 to 2019. A review of relevant published literature was also performed. Results: From 2003 to 2019, 5 pediatric patients underwent orbital reconstruction with split rib graft. Of the 5 patients, 3 were female and 2 were male with an age range of 4 to 8 years old (mean 4.8). Two patients had isolated orbital blow-out fractures while 3 presented with concurrent midfacial fractures. In each patient, the orbit was reconstructed by contoured split rib corticocancellous graft. Average length of stay was 5.2 days. There were no postoperative pneumothoraces. Mean follow-up length was 18.7 months, with no rib donor site complications. Each patient had adequate orbital volume restoration with no postoperative globe malposition or persistent diplopia. Conclusion: Pediatric orbital fractures are complex and challenging injuries. While alloplastic reconstruction is common and reliable, the risks of foreign body implantation and fixation must be carefully considered in patients who have not yet reached skeletal maturity. This is especially pertinent in younger patients as orbital growth continues until approximately 9 years of age. Rib graft use for adult orbital reconstruction has been explored. Data in the pediatric literature has not been identified. Corticocancellous rib graft harvest mandates a second surgical site; however, it is relatively inconspicuous with low postoperative morbidity. Corticocancellous rib grafting is a safe and durable option for orbital reconstruction and should be considered for use in the pediatric patient with a growing facial skeleton.

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