Applicability of an Unsintered Hydroxyapatite Particles/Poly-L-Lactide Composite Sheet with Tack Fixation for Orbital Fracture Reconstruction

Abstract

The aim of this retrospective clinical study was to evaluate the applicability of newly developed uncalcined and unsintered hydroxyapatite (u-HA) particles and poly-L-lactide (PLLA; u-HA/PLLA) composite sheets with tack fixation for navigation-assisted orbital fracture reconstruction. Osteosynthetic bone fixation and reconstruction systems made from u-HA/PLLA composites have recently drawn attention for effective application in maxillofacial bone surgery because of their osteoconductive properties and bioresorbability. One limitation of these systems in the clinical setting, however, is the complicated drill hole tapping that is required for screw fixation. Herein, we report the feasible application of a u-HA/PLLA sheet with tack fixation for intraoperative navigation-assisted orbital wall reconstruction; this approach may be suitable for fragile and anatomically complicated periorbital-maxillofacial bony regions. The study included 9 patients (mean age, 46.6 years) with moderate and medium complexity to large and high complexity orbital wall defects (3 type II defects and 6 type III). The mean follow-up period was 8.9 months (range, 6 to 18 months). Overall, the application of the u-HA/PLLA sheet with tack fixation gave excellent stability for orbital wall reconstruction at the infraorbital rim, and produced satisfactory ophthalmologic functional results with no intraoperative or postoperative complications. This material may be an optimal bioactive, osteoconductive, and bioresorbable bone alternative for orbital wall reconstruction with fewer complications in patients with orbital fractures.

Long-term Skeletal Stability of Computer-Assisted Maxillary Distraction Osteogenesis for Patients with Cleft Lip and Palate-Related Midfacial Hypoplasia

“…Thus, the hypernasality rating remained unchanged in all patients with distraction 15 mm. CAS can greatly improve outcomes in these types of complex oral and maxillofacial surgeries 7,14,17,18) . The use of 3D CT for reconstruction, for example, in DO and virtual planning, offers accurate, individualized assessments and treatment planning.…”

“…The use of 3D CT for reconstruction, for example, in DO and virtual planning, offers accurate, individualized assessments and treatment planning. The greatest advantage of CAS could be its ability to be combined with surgical navigation systems to confirm that the devices and surgical implants, such as distractors and reconstruction plates, fit both preoperatively and intraoperatively; in this way, it helps to create in an accurate digital environment for next-generation maxillofacial DO treatment, as described recently for maxillofacial trauma and reconstructive procedures and for maxillary DO 7,17,18).…”

Feasibility of Single Folded Unsintered Hydroxyapatite Particles/Poly-L-Lactide Composite Sheet in Combined Orbital Floor and Medial Wall Fracture Reconstruction

“…Orbital fractures with orbital defects are common in oral and maxillofacial surgery because of the exposed position and thin bony walls of the midface area 1,2) . Approximately 40% of orbital fractures occur in combination with other midfacial fractures, including zygomatic complex fractures, Le Fort II and III fractures, naso-orbital-ethmoid fractures, and frontal bone/orbital roof fractures, although they may occur alone 1,2) .…”

“…Approximately 40% of orbital fractures occur in combination with other midfacial fractures, including zygomatic complex fractures, Le Fort II and III fractures, naso-orbital-ethmoid fractures, and frontal bone/orbital roof fractures, although they may occur alone 1,2) . More than half inferior orbital wall medial fractures occur just medial to the junction between the infraorbital groove and inferior orbital fissure [1][2][3][4] .…”

“…On the other hand, Cho and Davies 3) reported a high revision rate (about 20%) in their study and discussed the difficulty of inserting a single large implant. Furthermore, the ideal shaping, modification, or anatomical positioning by spanning the wider bony defects with a single reconstructive implant may be technically challenging, requiring an experienced orbital trauma surgeon 1,[3][4][5] . Taken together, as this second approach, singleimplant repair, has been described by several authors 1,3,5,8) .…”