Options in orbital floor reconstruction in blowout fractures: a review of ten cases

Abstract

Objective The purpose of this case series was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with calvarial bone graft, titanium mesh or prolene mesh. Methods Ten cases of orbital blowout fractures treated at our centre from October 2006 to July 2008 were considered for this study. Clinical examination, patient satisfaction and radiographic investigations were used to assess repaired fractures. Results Prolene mesh was used in four cases, titanium mesh was used in four cases and calvarial graft used in two cases. Nine patients had significant improvement in their esthetic appearance. Symmetry was restored in all cases. All ten cases had a noticeable improvement in the function. Of total ten cases six had diplopia, three recovered completely during the six months after the surgery. Three cases showed improvement later. All ten cases with enopthalmos recovered completely. Of the nine patients with infraorbital numbness, all recovered completely during the six months following surgery. One patient where the reconstruction was done with calvarial bone graft showed mild discrepancy in the ocular level. Conclusion For small, linear defects measuring less than 2cm with enopthalmos and restricted ocular movements, prolene mesh (four cases) was used. For larger defects and impure blowout fractures involving the infraorbital rim, calvarial graft (two cases) or titanium mesh (four cases) was used. The outcome of surgery with all three materials was satisfactory. No postoperative complications were seen except for mild hypoglobus in a case reconstructed with calvarial graft. All three materials, calvarial graft, titanium mesh, prolene mesh, have the potential to be useful reconstructive materials in orbital floor blowout fractures.

Treatment with individual orbital wall implants in humans – 1-Year ophthalmologic evaluation

“…For larger defects and impure blow-out fractures involving the infraorbital rim, calvarial graft or titanium mesh are a typical choices. The outcome of surgery with all these materials is satisfactory (Shetty et al, 2009). We believe that titanium mesh is a versatile and predictable reconstructive material for orbital surgery.…”

Reconstruction of orbital floor for treatment of a pure blowout fracture

“…Rigid materials are best suited for reconstruction of large defects, to prevent sagging and displacement into the maxillary antrum. 11 Autogenous bone grafts, such as calvarium and iliac crest, are useful to repair facial bone defects, because of their strength, biocompatibility and osteogenic, osteoconductive, and osteoinductive potential. They share disadvantages like donor site morbidity, variable resorption rate, limited quantity and difficulty in molding in the appropriate shape.…”

“…3 The cortical bone from the calvarium satisfies the requirement of rigidity besides, its curvature is useful for floor reconstruction although its rigidity makes contouring nearly impossible. 11 In what concerns resorbable systems, a resorbable mesh plate used for orbital floor reconstruction has many advantages. It is easy to sculpt to fit in the defect and the operative time is significantly decreased.…”

Clinical management and reconstruction of isolated orbital floor fractures: The role of computed tomography during preoperative evaluation

“…Ilankovan [43] studied a case series of 222 patients and reported successful esthetic and functional outcomes by using calvarial bone graft. Shetty et al [44] compared the autogenous graft [calvarial bone graft] and alloplastic material (Prolene and titanium) in a case series including 10 patients, and found both materials appropriate for reconstruction, but noted the need for further studies with larger study populations. Prowse et al [36] conducted a study on a case series of 81 patients by employing silicone implant, titanium mesh, Lactosorb, Resorb X, and autogenous bone and cartilage, and reported that contrary to the literature, silicone implants could be used because of low infection and excursion rates as well as high patient satisfaction.…”