Resorbable Implants for Orbital Fractures

Ramesh, Sathyadeepak; Hubschman, Sasha; Goldberg, Robert A.

doi:10.1097/sap.0000000000001504

Cited by 23 publications

(33 citation statements)

References 71 publications

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“…As a result, the interest in biocompatible and resorbable implants has recently increased, and various materials including PDS, PLLA, PGA, PDLLA, and PCL of varying compositions have been introduced. PDS is a semi-crystalline polymer composed of p-dioxanone and degraded by hydrolysis, which loses half of its supportive strength after 3 weeks [8]. PDS gets rapidly resorbed in 6 months, and the scar following resorption was not enough to support the globe, especially in large defects [9].…”

Section: Discussionmentioning

confidence: 99%

“…PDS gets rapidly resorbed in 6 months, and the scar following resorption was not enough to support the globe, especially in large defects [9]. PGA is the simplest polyester and a highly crystalline material [8]; however, it degrades rapidly and its mechanical strength decreases by half in 2 weeks; thus, it needs to be copolymerized with other compounds [8]. PLLA is a semi-crystalline material with good strength and slow degradation due to its hydrophobicity [10].…”

Section: Discussionmentioning

confidence: 99%

“…As PLLA degrades slowly over 2 to 6 years by hydrolysis, it is commonly copolymerized with PGA or PDLLA in various compositions, which decides the degradation period and durability of each implant. PDLLA is a completely amorphous polymer that degrades fast, has low tensile strength, and is used as an implant in the PLLA/PDLLA compound [8]. Osteotrans-MX (Teijin Medical Technologies) is a bioactive and completely resorbable implant and is a compound of uHA particles (40 weight% in plates) and PLLA.…”

Section: Discussionmentioning

confidence: 99%

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Biodegradable implants for orbital wall fracture reconstruction

Jang

Kim

2020

Arch Craniofac Surg

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Background: Due to the different handling properties of unsintered hydroxyapatite particles/poly-L-lactic acid (uHA/PLLA) and polycaprolactone (PCL), we compared the surgical outcomes and the postoperative implantation accuracy between uHA/PLLA and PCL meshes in orbital fracture repair. Methods: Patients undergoing orbital wall reconstruction with PCL and uHA/PLLA mesh, between 2017 and 2019, were investigated retrospectively. The anatomical accuracy of the implant in bony defect replacement and the functional outcomes such as diplopia, ocular motility, and enophthalmos were evaluated. Results: No restriction of eye movement was reported in any patient (n = 30 for each group), 6 months postoperatively. In the PCL group, no patient showed diplopia or enophthalmos, while the uHA/PLLA group showed two patients with diplopia and one with enophthalmos. Excellent anatomical accuracy of implants was observed in 27 and 22 patients of the PCL and uHA/PLLA groups, respectively. However, this study showed that there were neither any significant differences in the surgical outcomes like diplopia and enophthalmos nor any complications with the two well-known implants. Conclusion: PCL implants and uHA/PLLA implants are safe and have similar levels of complications and surgical outcomes in orbital wall reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biodegradable implants for orbital wall fracture reconstruction

Jang

Kim

2020

Arch Craniofac Surg

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“…Therefore, this technique is useful for isolated floor or medial wall fractures with an intact bony buttress or a minimal fracture site [4]. However, these implants can undergo sagging or buckling due to an untimely loss of mechanical strength in large fractures [11], and they show a late enophthalmos rate of 5% to 16% [12]. The use of absorbable implants is a safe way to reduce implant deformation and complications from residual permanent implants in orbital wall restoration surgery [2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…The load bearing strength of mesh plates is adequate for use in isolated floor and medial wall fractures with an intact bony buttress, but they are not recommended for use in large orbital wall fractures that need load bearing support. Implants placed in large orbital wall fractures have been reported to show buckling and sagging due to the loss of their mechanical properties [11], and there is some risk of late enophthalmos after total absorption; thus, the long-term results are questionable [4]. The bone defect of the orbital wall became smaller as the fractured orbital wall was restored to prior position with patient's own orbital wall fragment.…”

Section: Orbital Wall Restoration With a Resorbable Mesh Platementioning

confidence: 99%

Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture

Kang

2019

Arch Craniofac Surg

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Most orbital surgeons believe that it's difficult to restore the primary orbital wall to its previous position and that the orbital wall is so thin that cannot be firmly its primary position. Therefore, orbital wall fractures generally have been reconstructed by replacing the bony defect with a synthetic implant. Although synthetic implants have sufficient strength to maintain their shape and position in the orbital cavity, replacement surgery has some drawbacks due to the residual permanent implants. In previous studies, the author has reported an orbital wall restoring technique in which the primary orbital wall fragment was restored to its prior position through a combination of the transorbital and transantral approaches. Simple straight and curved elevators were introduced transnasally to restore the orbital wall and to maintain temporary extraorbital support in the maxillary and ethmoid sinus. A transconjunctival approach provided sufficient space for implant insertion, while the transnasal approach enabled restoration of the herniated soft tissue back into the orbit. Fracture defect was reduced by restoring the primary orbital wall fragment to its primary position, making it possible to use relatively small size implant, furthermore, extraorbital support from both sinuses decreased the incidence of implant displacement. The author could recreate a natural shape of the orbit with the patient's own orbital bone fragments with this dual approach and effectively restored the orbital volume and shape. This procedure has the advantages for retrieving the orbital contents and restoring the primary orbital wall to its prior position.

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Orbital Anatomy

Ramesh

2022

Foundational Papers in Oculoplastics

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Resorbable Implants for Orbital Fractures

Abstract: Resorbable implants are suitable for isolated medial wall or floor fractures with intact bony buttresses and function as a barrier rather than a load-bearing support.

Cited by 23 publications

References 71 publications

Biodegradable implants for orbital wall fracture reconstruction

Biodegradable implants for orbital wall fracture reconstruction

Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture

Orbital Anatomy

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