Orbital wall restoring surgery with resorbable mesh plate

Abstract

BackgroundOrbital resorbable mesh plates are adequate to use for isolated floor and medial wall fractures with an intact bony buttress, but are not recommended to use for large orbital wall fractures that need load bearing support. The author previously reported an orbital wall restoring surgery that restored the orbital floor to its prior position through the transnasal approach and maintained temporary extraorbital support with a balloon in the maxillary sinus. Extraorbital support could reduce the load applied on the orbital implants in orbital wall restoring surgery and the use of resorbable implants was considered appropriate for the author’s orbital wall restoring technique.MethodsA retrospective review was conducted of 31 patients with pure unilateral orbital floor fractures between May 2014 and May 2018. The patients underwent transnasal restoration of the orbital floor through insertion of a resorbable mesh plate and maintenance of temporary balloon support. The surgical results were evaluated by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values.ResultsThe OVR decreased significantly, by an average of 6.01% (p< 0.05) and the preoperative and postoperative Hertel scale measurements decreased by an average of 0.34 mm with statistical significance (p< 0.05). No complications such as buckling or sagging of the implant occurred among the 31 patients.ConclusionThe use of resorbable mesh plate in orbital floor restoration surgery is an effective and safe technique that can reduce implant deformation or complications deriving from the residual permanent implant.

Orbital wall restoring surgery with primary orbital wall fragments in blowout fracture

“…Therefore, orbital wall fractures generally have been reconstructed by replacing the bony defect with an autologous bone graft or synthetic implant [2,3]. Although those implants are strong enough to maintain their shape and position in the orbital cavity, replacement surgery using this method has some drawbacks [2,4]. First, a large implant is required to bridge the entire fracture defect from the medial to lateral edges of the fracture.…”

“…Second, when an orbital fracture is repaired with an artificial implant without restoring the primary bone fragment, the thin flexible implant tends to be displaced into the paranasal sinus because there is no supporting structure. Third, per-manent non-resorbable alloplastic implants (e.g., titanium or porous polyethylene) are widely used, but can cause late complications including infection and foreign body reaction [4,5].…”

“…The author has reported an orbital wall restoring technique in which the primary orbital wall fragment is restored to its prior position through a combination of the transorbital and transantral approaches, and maintaining temporary extraorbital support in the maxillary and ethmoid sinus [2][3][4][5][6]. This dual approach procedure combines the advantages of each approach for retrieving the orbital contents and restoring the original natural shape of the orbital wall.…”

“…This dual approach procedure combines the advantages of each approach for retrieving the orbital contents and restoring the original natural shape of the orbital wall. A transconjunctival approach provided sufficient space for implant insertion, while the transnasal approach could minimize traction injury when restoring the herniated soft tissue back into the orbit from the sinus [2][3][4][5][6].…”

“…In this paper, the author summarizes five articles and a recent presentations reporting an orbital wall restoration technique that applied to pure medial, floor and large inferomedial fractures as well as combined orbital wall fractures and discusses the use of a resorbable mesh plate if there is no fracture defect after this restoration technique [4,7]. Four other papers were reviewed that evaluated the clinical outcomes of the orbital wall restoration technique [8][9][10].…”