Bioresorbable Material in Secondary Orbital Reconstruction Surgery

Abstract

Purpose. To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings. Methods. A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients’ demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed. Results. All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm (P<0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured. Conclusions. This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.

Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstruction

“…The present study is novel in presenting a large sample of patients who had undergone secondary orbital reconstruction with a PSI. The increased difficulties in secondary orbital reconstruction relating to scarring, distorted bony anatomy, soft tissue deformity, and the presence of pre-existing hardware has been described extensively in the literature 10,[35][36][37][38][39] . Several case studies describing PSI in secondary reconstruction have advocated their use specifically for secondary reconstruction 7,13,14,27,28 .…”

Orbital Soft Tissue Displacement After Blow-Out Fracture Repair Using Poly (L-Lactide-Co-Glycolide) Polymer Plates Based on Image Fusion Technique

“…Traditional repair materials for orbit are mainly composed of artificial materials that cannot be absorbed or degrade, therefore the long-term retaining of a foreign body results in an increased probability of complications such as infection and hemorrhage. 9 Along with the rapid development of tissue engineering, bioresorbable materials have become a hotspot and have been applied widely in clinic. 4 A 10-year retrospective study demonstrated the safety and effectiveness of bioresorbable materials in orbital fracture surgical repair.…”

Computer-Assisted Secondary Orbital Reconstruction

“…Pan et al could improve diplopia, exophthalmos, and ocular motility in 16 cases using Rapidsorb implants. 28 However, long-term results still have to follow and an ideal solution for secondary reconstruction has not yet been found. This innovative approach might be another step to provide best functional care and esthetic appearance for patients.…”