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Abstract
Purpose:
We present our experience with porous polyethylene/titanium implants in large orbital fractures that are difficult to repair with conventional orbital implants.
Methods:
A retrospective analysis was performed on seven patients who underwent repair of orbital fractures using porous polyethylene/titanium implants from September 2005 to December 2007.
Results:
The average age of the seven patients was 33.3 years, including two males and five females. The mean follow-up period was 5.4 months. Six cases had combined medial and inferior wall fractures, and one case had a large inferior wall fracture. Fractures were all large enough to encompass over 50% of the associated walls. After surgery, ocular motility disturbance and diplopia improved significantly. Enophthalmos improved from a mean of 2.9 mm to 0.6 mm postoperatively. No complications occurred such as visual loss, implant exposure or migration, or orbital infection.
References
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Figure 1.
The porous polyethylene/titanium implants consist of two sheets of porous polyethylene embedded with a thin titanium mesh.
Figure 3.
This 20-year-old female presented with facial deformity after a fall 10 days before surgery. (A, B) Note severe enophthalmos (6 mm) on preoperative photographs. Her ocular motility was severely restricted in all directions. (C, D) Preoperative coronal CT scans reveal large inferior and medial wall fractures extending to the posterior portion with two big bony fragments displaced into the adjacent sinuses. (E, F) Postoperative photographs (4 months) demonstrate resolution of enophthalmos. Ocular motility also improved.
Figure 4.
This 54-year-old female presented with diplopia and right enophthalmos following a motor vehicle collision 8 weeks prior to presentation. She had undergone initial orbital reconstruction elsewhere. (A, B) Preoperative photographs showing enophthalmos (5 mm) and generalized limitation of motility in the right eye. (C, D) Preoperative CT scans disclose large medial wall and floor fractures with herniation of orbital contents and displacement of implants (yellow arrows) into the adjacent sinuses. (E, F) Postoperative CT scans taken after 9 months confirm good placement of implants. Her enophthalmos resolved and ocular motility was almost full, except minimal restriction and diplopia on far upgaze. (G, H) Postoperative photographs taken after 2 years demonstrate the good restoration of orbital volume and symmetry. (red arrowheads=MedporⓇ Titan implant; yellow arrow=MedporⓇ Barrier sheet)
Table 1.
Summary of 7 patients treated for large orbital fractures with porous polyethylene/titanium implants
| Age(yrs)/Sex | Cause | Surgery delay (days) | Follow-up (months) | Inferior implants | Medial implants | |
|---|---|---|---|---|---|---|
| Patient 1 | 33/M | Assault | 18 | 3 | MTB∗1 | MTB∗1 |
| Patient 2 | 41/F | Fall | 14 | 5 | MTB∗1 | |
| Patient 3 | 20/F | Fall | 10 | 4 | MTB∗1 | MTB∗1 |
| Patient 4 | 23/F | Stick | 11 | 7 | MTB∗1 | |
| Patient 5 | 44/F | Stick | 12,045 | 4 | W†1 | MTB∗1 |
| Patient 6 | 54/F | Accident | 60 | 10 | MTB∗1, MC‡1 | MTB∗1, MB§1 |
| Patient 7 | 18/M | Assault | 19 | 5 | MTB∗1 | MB§1 |
Table 1.
Cont'd
| Diplopia | Gaze restrictions | Enophthalmos (mm) | Infraorbital hypesthesia | Complications | |||||
|---|---|---|---|---|---|---|---|---|---|
| Preop | Postop | Preop | Postop | Preop | Postop | Preop | Postop | ||
| Patient 1 | + | - | Moderate# | - | 3 | 1 | + | - | - |
| Patient 2 | + | - | Moderate# | - | 0 | 0 | + | - | - |
| Patient 3 | - | - | Severe‡ | Moderate# | 6 | 2 | + | - | - |
| Patient 4 | + | - | Moderate# | - | 2 | 0 | + | - | - |
| Patient 5 | - | - | - | - | 2 | 0 | - | - | - |
| Patient 6 | + | Improved∏ | Severe∗∗ | - | 5 | 0 | + | - | Sinus bleeding |
| Patient 7 | + | - | Moderate# | - | 2.5 | 1 | + | - | - |
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