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

Abstract

Background: Compared to isolated orbital wall fracture, combined orbital floor and medial wall fractures are more likely to be required surgical correction due to a higher possibility of complications. However, it remains a challenge to repair concomitant orbital fracture using a one-piece implant due to the complex anatomic structures of the orbit. Aiming to reduce surgical difficulties and enhance therapeutic effects, we repaired unilateral combined orbital floor and medial wall fractures using two separated modified titanium mesh plates in this study.Methods: A retrospective study was conducted on 21 consecutive patients who presented with unilateral combined orbital floor and medial wall fractures in Tianjin Medical University General Hospital between November 2010 and January 2016. The orbital fractures were repaired with two separated titanium mesh plates. The corner at the transition zone area between the orbital floor and the medial wall was reconstructed simultaneously through a combined transcaruncular and inferior subciliary approach with lateral canthotomy.The pre-and post-operative functions and aesthetic results were evaluated.Results: Preoperatively, all patients presented with 3.5-6.5 mm enophthalmos, five patients presented with diplopia with ocular motility limitation in injured eyes, and six patients presented with hypoglobus ranging from 1.5 to 3.5 mm. Orbital floor and medial wall fractures of all patients were successfully repaired with two separated titanium mesh plates. Postoperatively, enophthalmos was improved in all patients, which was less than 2 mm on the last follow-up day. Hypoglobus was disappeared in all six patients postoperatively. Diplopia was resolved in five patients within 3 months post operation, and was reduced in one patient.Conclusions: In cases of unilateral concomitant orbital floor and medial wall fractures, two titanium mesh plates implantation is a safe and effective procedure. It is worthwhile to take the technique into account when the key points to consider when applying this method include reconstruction of the special orbital shape and the complete return reposition of prolapsed intraorbital soft tissues were intended.

Tongue-in-Groove: A Novel Implant Design for a Blow-Out Fracture

“…In addition, since the ethmoid sinus and maxillary sinus wall can be a source of infection, it is important to minimize the damage with minimal manipulation of the sinus [ 31 ]. Another fixation method is to extend the implant to the rim and fix it to the rim side instead of the orbital wall [ 6 , 32 ], which has a disadvantage as it can cause an excessively large implant compared to the fracture site and it may not be in perfect contact with the orbital wall [ 7 , 30 ]. In addition, for rigid fixation of the implant, at least two screws must be inserted [ 32 ].…”

“…Another fixation method is to extend the implant to the rim and fix it to the rim side instead of the orbital wall [ 6 , 32 ], which has a disadvantage as it can cause an excessively large implant compared to the fracture site and it may not be in perfect contact with the orbital wall [ 7 , 30 ]. In addition, for rigid fixation of the implant, at least two screws must be inserted [ 32 ]. The fixation method using screws has a limitation as the screw may break during the fixation process, or the screw may loosen after fixation [ 33 ].…”

Reconstruction of Two Wall Orbital Fractures: Experience With the 3D Titan Implant and Intraoperative Computed Tomography

“…Surgical intervention is indicated to repair these large orbital fractures, with goals being: reconstructing the complex 3-dimensional shape of the orbital cavity, and repositioning the herniated intraorbital soft tissue. 10 Optimization of orbital bony anatomy with soft tissue repositioning aids in preventing (or treating) diplopia and enophthalmos. A transcaruncular approach incorporated with an inferior transconjunctival incision and lateral canthotomy has been shown to provide adequate exposure for large medial wall and orbital floor fractures.…”

Orbital Defect Reconstruction using Customized Implants: Current Techniques and Long-Term Outcomes in Maxillofacial Surgery.

“…(14,15) Because of the intricacy of the surgical procedures, it still presents a technical challenge for orbital surgeons even with the recent advancements in the creation of new implant materials and surgical technique. (16) In difficult circumstances, patient-specific implants (PSI) provide precise repair and symptom relief. They can be adjusted to the anatomy in order to correct or overcorrect the orbit's volume.…”