Accelerated Osteomesh Resorption: A Case Report

Abstract

Facial fractures occur commonly as a result of blunt trauma from road traffic accidents, assaults, and sporting injuries. Orbital floor fractures form a significant proportion of these and when large enough, the defect often requires surgical reconstruction of the floor to prevent orbital content herniation. Here, we present a case of a 28-yearold gentleman, who sustained an orbital floor fracture from a soccer-related injury. The resulting floor defect was surgically repaired using an osteomesh that was hand-cut to size. He developed delayed enophthalmos and entrapment of the inferior rectus muscle due to early resorption of the osteomesh, requiring revision surgery. KEYWORDS: Accelerated osteomesh resorption, orbital floor implant, orbital floor fractureFacial fractures form a significant bulk of the craniofacial trauma patient load in our center. This is due to a high volume of road traffic accident and workplace accident cases being sent to the emergency department here. A considerable number of these facial injuries include orbital floor fractures which may also be associated with orbital floor defects and the resultant herniation of orbital contents. The relief of the herniated contents, be it orbital fat or recti musculature, and the concomitant reconstruction of the orbital floor defect can be a challenging proposition.Here, we present a case report of a 28-year-old gentleman who was referred to our department after sustaining blunt orbital trauma to his right eye during a soccer game. His initial presentation was that of right periorbital swelling and pain. Clinical examination showed a right periorbital haematoma, decreased upward gaze of his right eye and diplopia on upward gaze.A CT scan of his orbits was performed, and blowout fractures of his medial wall and orbital floor were noted with resultant herniation of orbital fat and the right inferior rectus muscle (Fig. 1). He was brought to the operating theater and the herniated orbital contents were elevated out from the orbital floor defect; the 1 Â 1 cm orbital floor defect was reconstructed with a 1.5 Â 1.5 cm bioabsorbable Osteomesh that was fashioned to size. The Osteomesh implant was placed over the floor defect and was not anchored; the periosteum was closed over the implant. The forced duction test performed was normal. An on-table decision was made by the consultant-in-charge not to fix the medial wall defect. On postoperative day 1, he was noted to have complete resolution of his diplopia and the upward movement of his right eye was near full. He was discharged well and subsequently seen in the outpatient clinic.

Hybrid hyaluronic acid hydrogel/poly(ɛ‐caprolactone) scaffold provides mechanically favorable platform for cartilage tissue engineering studies

“…PCL has been approved by the FDA for use as a bioresorbable implant and suture material . It has been employed previously in cartilage tissue engineering applications .…”