Two-Year Follow-up on the Use of Absorbable Mesh Plates in the Treatment of Medial Orbital Wall Fractures

Abstract

BackgroundAbsorbable materials offer many advantages in the reconstruction of orbital walls; however, the possibility of postoperative enophthalmos after complete absorption cannot be excluded. We evaluated the postoperative results of absorbable mesh plates used as onlay implanting on the medial orbital wall to determine whether they are suitable for medial orbital wall reconstruction.MethodsThe study included 20 patients with medial orbital wall fractures who were followed up for more than 2 years postoperatively. We used absorbable mesh plates in all of the patients. We measured the following: the changes in the expanded orbital volume by comparing the preoperative and postoperative computed tomography (CT) scans and the degree of clinical enophthalmos.ResultsThere were no major complications associated with the use of absorbable materials such as infection, migration, or extrusion of mesh plates during the long-term follow-up. The orbital volumetric changes between the preoperative and postoperative CT scans were not statistically significant. However, the expanded orbital volume was not related to the degree of clinical enophthalmos.ConclusionsThe reconstructed orbital wall may provide supportive scar tissue to the orbital contents even after the absorbable materials have dissolved completely. Absorbable mesh plates could be another option for the reconstruction of the medial orbital wall.

Comparison of Absorbable Mesh Plate versus Titanium-Dynamic Mesh Plate in Reconstruction of Blow-Out Fracture: An Analysis of Long-Term Outcomes

“…Diagnosing these types of traumas has been difficult in the Comparison of Absorbable Mesh Plate versus Titanium-Dynamic Mesh Plate in Reconstruction of Blow-Out Fracture: An Analysis of Long-Term Outcomes past, so the diagnosis rate has been low. With the development of new diagnostic modalities, it is now relatively easy to diagnose and confirm orbital wall fractures [2][3][4][5]. Accordingly, orbital fracture reconstruction has become a common procedure for plastic surgeons to perform.…”

Orbital wall restoring surgery with resorbable mesh plate

“…The resorbable mesh plate retains its mechanical strength over 1 to 2 years, allowing for adequate fibrous tissue formation on the bony orbital wall defect, after which it is degraded and absorbed completely, minimizing the risk of foreign body reaction [3]. Therefore, it is useful in isolated floor or medial wall fractures with an intact bony buttress or minimal fracture site [6,13,14]. However, these implants can undergo sagging or buckling due to untimely loss of mechanical strength in large fractures [4,5,15], and they show a late enophthalmos rate of 5% to 16% [3].…”

“…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 loadbearing support. Buckling and sagging of implants due to loss of their mechanical properties has been reported in large orbital wall fractures [4,5], and there is a high possibility of late enophthalmos after total absorption; thus, the long-term results are questionable [3,6].…”

Medial Wall Orbital Reconstruction using Unsintered Hydroxyapatite Particles/Poly L-Lactide Composite Implants

“…Baek et al [ 11 ] compared the long term results of titanium mesh plate and absorbable implant, in which study implant rigidity was evaluated for postoperative complications including diplopia and enophthalmos. You et al [ 2 ] also studied the long term results after absorbable implant reconstruction by measuring the difference in herniated soft tissue between preoperative and postoperative observations. The authors believed that herniated volume difference or postoperative enophthalmos was more dependent on surgical skills than the natural rigidity or durability of an implant.…”

“…The ideal implant for blow-out fracture reconstruction should have good biocompatibility, strength to contain orbital contents, sterilizability, and plasticity to shape the implant [ 1 2 ]. The implant would be radiopaque, to enable radiographic evaluation after surgery, but should not produce artifacts.…”