Posttraumatic orbital reconstruction has been a challenging mission for decades in craniomaxillofacial surgery. Complications like enophthalmos, diplopia and gaze obstacles emerge when orbital trauma occurs, affecting people's daily life as well as their appearance. Advances in technology and research gained through years of experience has provided us with a greater understanding of the changes following trauma, as well as providing us with a variety of filling materials that we can choose from to handle the deformities. However, the best type of material for repair of orbital deformities remains controversial. This paper reviewed approximately 60 articles discussing materials used in orbital reconstruction or soft tissue defect filling in the past years, with the aim of giving a comprehensive overview of the advantages and disadvantages of materials used in this field so as to help surgeons to make a better choice.
Craniomaxillofacial and plastic surgeons are often confronted with patients who present with enophthalmos caused mainly by trauma. In many patients, one-stage reconstruction repairs only the bony orbit, leaving intact the disfiguring enophthalmos. Thus, some filler is needed to restore the normal volume of the orbit. The authors describe a technique to correct such deformation safely and effectively. Data were collected from 30 enophthalmic patients (average age 36.67 ± 11.66 years) who underwent retro-ocular injections of fat globules between August 2014 and July 2018. CT helped identify a safe injection site, and specific CT measurements quantified the volume of fat globules required. There was a significant difference between the preoperative and postoperative values for lateral orbital protrusion (P < .01), superior orbital protrusion (P < .01), and orbital volume (P < .01). Most patients were satisfied with the outcome. There were no significant complications. Injecting fat globules into the retro-orbital area is an effective technique for correcting enophthalmos deformity.
Rib regeneration occurred more quickly by in situ rib splitting harvesting approach compared with the traditional surgical approach.
Fat repositioning is an effective way to treat tear trough deformity (TTD) in Asians. Recent techniques mainly focused on the fixation technique, whereas how to precisely shape and individually quantify the fat pedicle has been ignored. This article introduced an individualized, targeted, and tension-free technique to fabricate a fanshaped thin septum fat pedicle for repositioning. Furthermore, a layer-level fixation method was advocated to provide sufficient, continuous, uninterrupted filling of the TTD. From January 1, 2009, to December 31, 2018, 492 patients underwent this procedure. Through a transconjunctival incision, a continuous fan-shaped, tension-free, customized septum fat pedicle was precisely designed to match the TTD anatomy. The pedicle could either be elongated, or thickened, or debulked, or translocated, to meet the patients' individual needs. At the same time, a layer-level fat pedicle fixation technique was applied to fully interrupt the TTD. The mean operation time was 60 AE 9.3 minutes. All patients demonstrated a significant improvement with elimination of both eye bags and TTD. High satisfaction was noted among the patients. No obvious resorption of the fat pedicles was observed, and the lower lid contour improvements were durable. One infection occurred after 3 days of surgery, and was resolved by removal of the suture followed by topical application of iodine and oral antibiotics for 3 to 5 days. No other complications were observed. Precisely repositioning transconjunctival fat using a layer-level fixation technique with a fan-shaped thin fat pedicle under a subperiosteal plane is an effective, lasting, and safe approach for individually treating TTD.
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