Orbital Adherence with Titanium Mesh Floor Implants: A Review of 10 Cases

Kersey, Thomas; Ng, Stephen G J; Rosser, Paul; Sloan, Brian; Hart, Richard H.

doi:10.3109/01676830.2012.736597

Cited by 34 publications

(31 citation statements)

References 10 publications

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“…Polydioxanone maintains up to 12 month in the orbital soft tissue until full degradation, sometimes degradation seems to be incomplete and granulomas occur more often due to a sterile inflammatory cellular reaction lining the degrading polymer fragments. On the other hand a vigorous fibrotic reaction can also be seen in patients with titanium mesh implants [ 11 ]. And furthermore an increased rate of infection, extrusion, implant migration and residual diplopia has also been reported for patients reconstructed with titanium meshes [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

et al. 2016

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BackgroundMany reconstruction materials for orbital floor fractures have been described in the past including autologous bone transplants, resorbable polymers and titan meshes. So far evidence is missing which material is used successfully regarding indication and particular size of defect. Therefore the aim of this study was to evaluate which reconstruction technique produces best clinical outcome and least complications associated with indication.MethodsRetrospectively, surgical and ophthalmological data plus CT scans from a collective of 775 patients between 2005 and 2012 were analyzed. Furthermore included patients were sounded on satisfaction and potential problems postoperatively.ResultsOverall 593 patients offered full pre- and postoperative short-time data appropriate to inclusion criteria – of these 507 (85,5 %) underwent primary surgical treatment. Smallest average defect size was found in cases with no indication for surgical treatment (81 mm2), largest in cases indicating titanium mesh reconstruction (601.5 mm2). In 15 cases exact fragment reposition was possible without insertion of alloplastic material. Best clinical results obtained reconstruction using polydioxanone foil (PDS). 0.15 mm PDS-foil: 444 patients, reduced diplopia pre to postoperative 16 to 6 % (p < 0.01), ex- and enophthalmus < 2 % after surgery. 0.25 mm PDS-foil: 26 patients, reduced diplopia from pre- to postoperative 34,6 to 3,8 % (p < 0.01), postoperative exophthalmus rate was higher than preoperative (3,8 to 7,7 %). In comparison to reconstruction with PDS-foil a higher percentage of patients reconstructed with titanium meshes (n = 22) revealed no significant reduction of diplopia (45,5 to 31,8 %; p = 0.07). Furthermore 63 of all included patients agreed to complete a questionnaire on intermediate-term postoperative symptoms and surgical contentedness. Remarkably 50 % of the patients reconstructed with titanium meshes indicated foreign body sensations and cold feeling in the long-term.ConclusionsShort- and intermediate-term results of clinical outcome in our patients with surgical treated orbital floor fractures (i.e. diplopia, en- or exophthalmus) reveal that thin resorbable foils, particularly 0.15 mm diameter PDS-foil seem to generate best results referring to orbital floor defects with a size of 250 to 300 mm2.Trial registrationStudy number 4222, year 2013, ethics committee of the medical faculty of the Heinrich Heine university of Duesseldorf.

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Section: Introductionmentioning

confidence: 99%

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

et al. 2016

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“…In the study of Kersey et al, all operatively managed cases were noted to have an improvement in globe movement on forced-duction test. 11 There was no mention of the forced-duction test for the conservatively managed patients, or in the study of Lee and Nunery. 10 We hypothesize that patients with a negative forced-duction test (Case 2) are likely to have cicatricial scarring and fibrous ingrowth into the orbital mesh to a lesser degree as compared with patients with a positive forced-duction test.…”

Section: Discussionmentioning

confidence: 99%

Orbital Adherence Syndrome following the Use of Titanium Precontoured Orbital Mesh for the Reconstruction of Posttraumatic Orbital Floor Defects

Lee

2017

Craniomaxillofacial Trauma & Reconstruction

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Orbital blowout fractures are a common occurrence following orbital trauma. Depending on the size of the defect and the contents that have herniated or incarcerated, possible sequelae include enophthalmos, diplopia, dystopia, and entrapment. Surgical intervention aims to prevent or alleviate this through the use of a bone graft or an alloplastic implant to reconstitute the continuity of the orbit. However, in doing so, the implant itself may result in the unexpected adherence of the periorbita, resulting in orbital adherence syndrome. We present two cases of orbital adherence syndrome following the use of titanium mesh for orbital floor reconstruction. In both cases, we also delineate the management of this syndrome. Our first patient reported good recovery after surgical intervention to relieve the tethering to the titanium mesh and subsequent placement of a smooth interface implant. The other patient was managed nonsurgically with resolution of symptoms. We highlight possible signs that might suggest the need for early surgical intervention. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery.

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“…However, the cause of this syndrome is still controversial. Lee and Nunery [11] hypothesized that the titanium material itself was the cause of the adhesions, but Kersey et al [12] explained that the fracture itself frequently leads to a splitting or rupture through the periorbita, leading to adhesion by inadequate separation between the orbital contents and the bone or the implant. Thus, avoidance of titanium implants may be unwarranted if solely to avoid a complication that may occur with or without the titanium mesh.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Pre-Bent Titanium Implant for Concomitant Orbital Floor and Medial Wall Fractures in an East Asian Population

et al. 2014

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BackgroundThe objective of this article is to evaluate clinical outcomes of combined orbital floor and medial wall fracture repair using a three-dimensional pre-bent titanium implant in an East Asian population.MethodsClinical and radiologic data were analyzed for 11 patients with concomitant orbital floor and medial wall fractures. A combined transcaruncular and inferior fornix approach with lateral canthotomy was used for the exposure of fractures. An appropriate three-dimensional preformed titanium implant was selected and inserted according to the characteristics of a given defect.ResultsFollow-up time ranged from 2 to 6 months (median, 4.07 months). All patients had a successful treatment outcome without any complications. Clinically significant enophthalmos was not observed after treatment.ConclusionsThree-dimensional pre-bent titanium implants are appropriate for use in the East Asian population, with a high success rate of anatomic restoration of the orbital volume and prevention of enophthalmos in combined orbital floor and medial wall fracture cases.

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Orbital Adherence with Titanium Mesh Floor Implants: A Review of 10 Cases

Cited by 34 publications

References 10 publications

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

Orbital floor fractures – short- and intermediate-term complications depending on treatment procedures

Orbital Adherence Syndrome following the Use of Titanium Precontoured Orbital Mesh for the Reconstruction of Posttraumatic Orbital Floor Defects

Three-Dimensional Pre-Bent Titanium Implant for Concomitant Orbital Floor and Medial Wall Fractures in an East Asian Population

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