Endoscopic endonasal repair with polyethylene implants in medial orbital wall fractures: A prospective study on 25 cases

Abstract

The aim of the study was to assess the mid-term effectiveness and safety of an original technique consisting of reconstructing fractures of the medial wall of the orbit with porous polyethylene implants with an exclusive transnasal approach. Twenty-five patients were treated. Each patient underwent a pre-operative ophthalmologic evaluation and a CT scan. The surgery started with an anteroposterior ethmoidectomy of the fractured side; all the fractured bone fragments were removed and all usual landmarks of healthy bony margins were identified. A Medpor sheet was placed endoscopically to reconstruct the fractured wall. Each patient received an immediate postoperative CT scan, and was evaluated at day 1, 7, 30 and 6 months after surgery clinically and with an endoscopic examination. In all patients, preoperative enophthalmos and/or diplopia were corrected. The CT scans showed excellent reconstruction of the fractured bony walls. The immediate postoperative period was characterized by a very high degree of subjective comfort. No perioperative complications were detected. At the 6 months follow up, all meshes appeared covered by epithelialized mucosa at the endoscopic inspection, and clinical results were stable. Scars or lid complications are always prevented. The technique described has become the standard to treat medial wall fractures in our department.

Repair of unilateral combined orbital floor and medial wall fracture using two titanium mesh plates: a modified technique

“…Various implant materials have been used for orbital fracture repairs, such as autologous bone grafts (24,25), porous polyethylene (26,27), polydioxanone (28,29), bioresorbable polylactide plates (30,31), silicone (32,33), smooth nylon foil (34,35), and titanium mesh (36,37). However, it is still controversial to figure out the ideal implant materials and methods for orbital floor and medial wall fracture repairment (38).…”

Development of Chronic Sphenoid Sinusitis After Sellar Reconstruction with Medpor Porous Polyethylene Implant

“…14,19,22 In addition, the rapid soft tissue integration of the implant allows for increased stabilization rate, reducing the risk of implant migration and extrusion. 19,23 Other potential benefits of a porous polyethylene implant are that it is highly inert and does not induce significant foreign body reaction in the surrounding tissue. 9,20 Major disadvantages of these implants are their radiolucency, which limits its evaluation on postoperative imaging, its permanency and its inherent avascular nature that is at risk when exposed to microbial colonization in the sinuses.…”

The Reconstruction of the Medial Wall of the Orbit: A Change in Philosophy

“…Since few years we introduced a new method to treat MWF using a pure transnasal approach, through which we were able to properly reconstruct the fractured medial wall with a polyethylene mesh, appropriately shaped [3]. Since then we have used this technique to treat all isolated MWF [4]. We believe that this approach is superior as compared to conventional external approaches because it allows to clearly visualize and control the whole wall, included its posterior and upper part, that are, as said, poorly managed with external approaches.…”