Reconstruction of Traumatic Orbital Floor Fractures With Resorbable Mesh Plate

Abstract

Various materials such as autogenous bone, cartilage and alloplastic implants have been used to reconstruct orbital floor fractures. A new material is needed because of disadvantages of nonresorbable alloplastic materials and difficulties in harvesting autogenous tissues. In this study safety and value of the use of resorbable mesh plate in the treatment of orbital floor fractures are discussed. Between 2002 and 2004 a total of 17 maxillofacial trauma patients complicated with orbital floor fractures were treated with resorbable mesh plate through subciliary or transconjunctival incisions. Pure blow-out fractures were determined in 6 patients and 11 patients had accompanying maxillofacial fractures. Resorbable plate was easily shaped to fit to the orbital floor by cutting with scissors. Patients were evaluated clinically and with computed tomography scans preoperatively and at 3-, 6- and 12-month intervals postoperatively. Twelve patients had preoperative enophthalmos. Two patients had diplopia that was corrected postoperatively. In all 17 cases there was no evidence of infection, diplopia and gaze restriction postoperatively. Scleral show appeared in three patients by the second postoperative week but resolved totally within 3 to 6 weeks except one patient. In this patient anterior displacement of mesh was evident which caused ectropion and enophthalmos and required re-operation. No any other mesh related problems were seen at 15 months mean follow-up time. The advantage of the resorbable mesh system in orbital floor fracture is the maintenance of orbital contents against herniation forces during the initial phase of healing and then complete resorption through natural processes after its support is no longer needed. Our experience represents that resorbable mesh is a safe and effective material for reconstruction of the selected, non-extensive orbital floor fractures.

Comparative Study of Enophthalmos Treatment with Titanium Mesh Combined with Absorbable Implant vs. Costochondral Graft for Large Orbital Defects in Floor Fractures

“…Its mechanical strength lasts between two and three months and complete reabsorption until 9-15 months. Reabsorption is by hydrolysis, and this is other advantage because it does not produce in lammatory reaction [8,[18][19][20][21].…”

“…Reported post-surgery complications using absorbable materials alone for reconstructive procedures of orbital loor are from 3 to 25 % [5][6][7][8][9] and with synthetic materials are from 7.4 to 18% [10,11], this is talking about small defects mostly, however, there are reports with complications of 25% using titanium mesh combined with Lactosorb in large defects [11]. Combining these two materials prices raise, that is why the purpose of this study is to compare results using autologous material versus synthetic material plus absorbable implants for the reconstruction of orbital loor with large defects, and, determine superiority of costochondral graft making evident the improve with complication rates and recurrence of enophthalmos.…”

Biomateriais para reconstrução da órbita: revisão da literatura

“…Dentre os materiais absorvíveis temos a tela de poliglactina e as placas de polidioxanona. Estes, contudo, também não apresentam todas as características do material ideal, visto que são corpos estranhos, interpretados como antígeno pelo organismo, com potencial de reação variável pelo hospedeiro 20,21 . Existem outros produtos disponíveis no mercado, alguns sem avaliação a longo prazo, o que se torna uma preocupação, devido ao surgimento de complicações ainda imprevisíveis.…”

Enxerto auricular autógeno em reparo de fratura blow-out

“…Defeitos estéticos e funcionais são frequentes quando tal comorbidade é negligenciada ou tratada inadequadamente 4 . Os achados clínicos incluem equimose e edema periorbital, restrição de movimentação ocular, diminuição da acuidade visual, diplopia, enoftalmia, hipoestesia ou anestesia infra-orbital 5 . O diagnóstico por imagem utiliza-se de radiografia em incidências póstero-anterior e mento-naso, porém o padrão ouro é a tomografia computadorizada (TC) especialmente em cortes coronal e sagital 6,7 .…”