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

Abstract

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.

New Algorithm for the Management of Orbital Blowout Fracture Based on Prospective Study

“…We performed a quantitative computational method for calculating the area of the fractures and the walls. 16,17 Stacks of 2mm slices were made in the coronal plane. The width of the inferior or medial orbital wall in each 2-mm-slice was measured.…”

Use of bioresorbable implants for orbital fracture reconstruction

“…Avashia et al 23 developed a decision-making algorithm for orbital floor reconstruction materials by reviewing all available literature, but found no conclusive statement regarding the preferred material for orbital floor fracture repair. Other studies comparing implants also found no significant difference in outcomes between absorbable mesh plates and titanium-dynamic mesh plates, Macropore and Medpor, or (PDS) foil and titanium meshes 2 23…”

Prospective Randomized Controlled Pilot Study on Orbital Blowout Fracture

“…We performed a quantitative computational method for calculating the area of the fractures. 19,20 Stacks of 2-mm slices in the coronal plane were created. The width of the fractured orbital wall in each 2-mm slice was measured.…”