Reconstruction of Medial Wall Blowout Fracture Defect with a Combination of Resorbable Meshed Plate and Cancellous Bone Allograft

Abstract

Background Various materials are available for the reconstruction of bone defects in cases of medial wall blowout fracture. This study was conducted to assess the efficacy of the combination of a resorbable meshed plate and cancellous bone allograft. Methods From March 2014 to March 2017, a total of 111 patients were evaluated. Sixty-three patients received reconstruction surgery with porous polyethylene plates (control group) and the other forty-eight patients underwent operation with a resorbable meshed plate plus allogenic cancellous bone (combined group). The results were assessed by exophthalmometric measurements, width, and volume discrepancies as compared with the unaffected orbit, and operation time. Results The difference in exophthalmometric measurements between the affected and unaffected orbits were 0.94 ± 0.70 mm in the control group and 1.05 ± 0.73 mm in the combined group without statistical significance (p = 0.425). In the analysis of computed tomography images, the width discrepancy was 1.55 ± 0.86 mm and 1.08 ± 0.69 mm, respectively (p = 0.003); however, the volume discrepancy demonstrated no statistically significant difference (2.58 ± 1.40 cm3 versus 2.20 ± 1.80 cm3; p = 0.209). Operation time was significantly shorter in the combined group as compared with the control group (43.0 ± 7.0 versus 38.3 ± 7.0 minutes; p = 0.001). Conclusion The combination material composed of resorbable meshed plate and cancellous bone allograft made reconstruction surgery of medial wall blowout fracture easier and quicker to perform with long-lasting results.

Reconstruction of Medial Orbital Wall Using Autologous Perpendicular Plate of Ethmoid

“…The ethmoidal cardboard that makes up medial orbital wall is about 0.2 to 0.4 mm and therefore more susceptible to orbital burst-out fractures. 2,6,13,14 After burst-out fracture, the volume of orbit increases, resulting in inverted eyeballs. In addition, orbital soft tissue and medial rectus muscle may become incarcerated, leading to diplopia, limited ocular motility, retinal edema, anterior chamber hemorrhage, vision loss, and the most severe outcome can lead to blindness.…”

“…Currently commonly implant materials used in orbital reconstruction surgery are bone and cartilage autologous bone grafts, allogeneic bone, porous polyethylene, absorbable sheets and other artificial synthetic materials. 5,6,16,17 Cancellous bone allograft can be used as a substitute for the medial orbital wall not only because of its osteoconductive and osteoinductive abilities, but also because of its elasticity and volume-filling effect, mimicking the ethmoid space. Shin and colleagues chose a sponge-type allograft material (Genesis sponge), which uses demineralized cancellous bone to induce mesenchymal cell proliferation and osteoblast differentiation to help form normal bone.…”

“…Nowadays, various materials of reconstruction are used to reconstruct medial orbital wall. [3][4][5][6] During the septoplasty, we found the bony nasal septum that we removed is very similar in strength and thickness to medial orbital wall. And theoretically it may be an ideal material for the reconstruction of the medial orbital wall.…”

Precisely Tuning the Pore-Wall Surface Composition of Bioceramic Scaffolds Facilitates Angiogenesis and Orbital Bone Defect Repair

“…Congenital or degenerative diseases, as well as inflammation from autoimmune diseases, tumors, or trauma, can all cause orbital bone damage, which is one of the leading causes of facial deformity, eye position abnormalities, and visual dysfunction. , The conventional treatment is autologous or allogeneic bone transplantation, , although these methods show the intrinsic limits and morphological restrictions of graft donors. In this aspect, some injectable hydrogel biomaterials were thought to be versatile for a variety of irregular, thin-wall orbital bone structures .…”

Technical Note on Three- and Four-Wall Orbital Reconstructions With Patient-Specific Implants

“…Resorbable alloplastic materials should only be used to reconstruct class I defects. 9,10 For the reconstruction of relatively simple defects (class I/II), various materials can be utilized, from autologous materials 11 to alloplasts. 8,12,13 Large, complex defects (class III-V) require more surface area to be covered, implying more stability from the reconstruction material.…”