The Role of Resorbable Plate and Artificial Bone Substitute in Reconstruction of Large Orbital Floor Defect

Abstract

It is essential to reduce and reconstruct bony defects adequately in large orbital floor fracture and defect. Among many reconstructive methods, alloplastic materials have attracted attention because of their safety and ease of use. We have used resorbable plates combined with artificial bone substitutes in large orbital floor defect reconstructions and have evaluated their long-term reliability compared with porous polyethylene plate. A total of 147 patients with traumatic orbital floor fracture were included in the study. Surgical results were evaluated by clinical evaluations, exophthalmometry, and computed tomography at least 12 months postoperatively. Both orbital floor height discrepancy and orbital volume change were calculated and compared with preoperative CT findings. The average volume discrepancy and vertical height discrepancies were not different between two groups. Also, exophthalmometric measurements were not significantly different between the two groups. No significant postoperative complication including permanent diplopia, proptosis, and enophthalmos was noted. Use of a resorbable plate with an artificial bone substitute to repair orbital floor defects larger than 2.5 cm2 in size yielded long-lasting, effective reconstruction without significant complications. We therefore propose our approach as an effective alternative method for large orbital floor reconstructions.

Orbital Floor Reconstruction: A Comparison of Outcomes between Absorbable and Permanent Implant Systems

“…20 However, others postulate that absorbable plates are a reasonable option for large orbital floor fractures, especially when combined with bone substitute, because orbital contents are not load-bearing. 21 In our study, the mean fracture surface area was 2.1 (SD: AE 0.9 cm 2 , range: 0.4-3.6 cm 2 ) and 2.3 cm 2 (SD: AE 1.01 cm 2 , range: 0.6-4.4 cm 2 ) for the absorbable and nonabsorbable groups, respectively, a fracture size which we would describe as moderate. Given that there were no significant differences in either outcomes or complications between absorbable and nonabsorbable implants, this suggests that for fractures of a moderate size, absorbable implants are a viable option, a finding consistent with prior studies.…”

Correction of post-traumatic enophthalmos with anatomical absorbable implant and iliac bone graft

“…The postoperative discomfort and temporary diplopia incidence rate were very low because the absorbable plate helped to smooth the inner lining of the orbital wall. In addition, absorbable plates are considered appropriate for maintaining long-term orbital wall lining [11]. In the cases presented in that report, we used artificial bone substitutes, which provided sufficient volume to cover small defects such as orbital wall fractures, but would be insufficient to provide the volume needed for enophthalmos correction; furthermore, that technique would not be cost-effective.…”

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

“…Their safety, simplicity, and effectiveness without donor site morbidity or permanent residue make them popular. However, a debate remains about their long-term efficacy because of their low strength and limited durability [1, 4].…”

“…Blowout fracture is defined as a fracture that involves the orbital walls, especially the medial wall and/or orbital floor [1]. It may be one of the most commonly encountered facial bone fractures by physicians because of the exposed position of the globe and the relatively thin properties of the orbital bone [2].…”

“…Various substances such as autogenous materials (e.g., autologous bone, cartilage, and fascia), allogenic materials, nonresorbable alloplastic materials (e.g., titanium, porous polyethylene, hydroxyapatite), and resorbable alloplastic materials (e.g., poly-L-lactic acid, polyglycolic acid, polyglactin, composite polymers) can be used in the reconstruction of medial orbital wall fractures and defects [1, 5, 6]. Recently, resorbable alloplastic materials have become one of the most popular implant options because of their safety, simplicity, and effectiveness without donor site morbidities or permanent residues.…”