Results of Reconstruction of Orbital Wall Fracture With Bioresorbable Plate

Hun-Sub Lim; Koung Hoon Kook

doi:10.3341/jkos.2009.50.12.1761

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Lim and Kook: Results of Reconstruction of Orbital Wall Fracture With Bioresorbable Plate

Original Article

J Korean Ophthalmol Soc 2009;50(12):1761-1767.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.12.1761

Results of Reconstruction of Orbital Wall Fracture With Bioresorbable Plate

Hun-Sub Lim, MD, Koung Hoon Kook, MD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

Address reprint requests to Koung Hoon Kook, MD, Department of Ophthalmology, Ajou University School of Medicine #San 5 Woncheon-dong, Yeongtong-gu, Suwon 443-749, Korea Tel: 82-31-219-5260, Fax: 82-31-219-5259, E-mail: drkook@ajou.ac.kr

Received 12 March 2009 Accepted 17 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the long-term results and complications of orbital wall fracture reconstruction using the bioabsorbable orbital implant, Macropore^® orbital floor liner.

Methods

This retrospective study included patients who underwent the reconstruction of an orbital wall fracture using Macropore^®

orbital floor liner and completed a postoperative follow-up longer than 6 months. The enophthalmic values as well as the data of ocular movement and diplopia was collected from the medical records of each patient and analyzed.

Results

A total of 35 patients were evaluated with an average follow-up period of 14.0 months. The average enophthalmic value of 29 patients, whose reconstruction was primarily indicated from enophthalmic tissue, was 0.90 mm at the last follow-up. No significant progression of enophthalmos was observed at postoperative 12, 18 and 24 months when compared with the enophthalmic value at postoperative 6 months. All 15 patients who have had the limitation of ocular movement or diplopia preoperatively resolved completely or improved to the degree that no clinically significant limitation or diplopia further existed. No complications such as dislocation of implant, infection, and aggravation of ocular limitation were observed during the follow-up period.

Conclusions

Macropore^® orbital floor liner may be regarded as a useful implant in reconstruction of orbital wall fracture with no significant implant-related complications during its absorption.

Keywords: Bioabsorbable plate, Enophthalmos, Macropore, Orbital wall fracture

References

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Figure 1.

Classification of orbital wall fracture according to the percent of bony defect in coronal CT scan in which the maximum defect is observed. (A) Small size fracture: less than 25% of bony defect, (B) Medium size fracture: between 25 and 75% of defect. (C) Large size fracture: more than 75% of defect.

Figure 2.

The enophthalmic values of patients during follow-up periods.

Figure 3.

Preoperative (A) and immediate postoperative (B) CT of the patient who showed 3 mm of enophthalmos at postoperative 6 months. (A) Large-size right inferior orbital wall fracture is noted preoperatively. (B) Well reconstructed inferior orbital wall with Macropore^® orbital floor liner is observed (arrow).

Figure 4.

Computerized tomography (CT) of patient who were followed up to postoperative 24 months. (A) Large size right inferior orbital wall fracture is noted preoperatively. (B) In immediate postoperative CT scan, orbital floor is well reconstructed with Macropore, which is seen as a radiolucent line. (C) The contour of orbital floor including inferior rectus muscle is well maintained at postoperative 24 months. The area where Macropore was located previously is replaced by soft tissue (probably thought as fibrotic tissue) (short arrow), and the line with bone density outlines the orbital floor, which suggests calcification (long arrow).

Table 1.

Demographic data of patients

Characteristics		Number of patients (%)
Sex	Male	25 (71.4)
	Female	10 (28.6)
Cause of trauma	Violence	16 (45.7)
	Fall down	8 (22.9)
	Sports	3 (8.6)
	Traffic accident	6 (17.1)
	Others	2 (5.7)
Involved wall	Medial wall	12 (34.3)
	Inferior wall	20 (57.1)
	Both	3 (8.6)
Size of fracture^*	Small	6 (17.1)
	Medium	9 (25.8)
	Large	20 (57.1)

^* The percent of the bony defect to the involved orbital wall on coronal CT scans in which largest bony defect was observed. (Small size=less than 25%; medium size=between 25 and 75%; large size=more than 75%)

Table 2.

The enophthalmic values of patients at postoperative follow-up periods (mm)

Follow up	Postoperative 6 months	Postoperative 12 months	Postoperative 18 months	Postoperative 24 months
24 months (n=7)^†	1.00±0.71	0.93±0.79^*	0.86±0.85^*	0.86±0.85^*
18 months (n=13)^‡	1.04±0.80	1.08±0.86^*	1.00±0.91^*	N/A
12 months (n=20)	1.00±0.87	0.83±0.92^*	N/A	N/A

^* Statistical analysis with the value of postoperative 6 months, p>0.05

^† Six patients out of thirteen in ‘18 months' group were lost in follow up at postoperative 24 months

^‡ Seven patients out of twenty in ‘12 months' group were lost in follow up at postoperative 18 months; N/A=not applicable.

Table 3.

The number of patients showing limitation of ocular movement and diplopia according to each grade at preoperative and last follow up

	Limitation of motion^*		Diplopia^†
	Preoperative	Postoperative	Preoperative	Postoperative
Grade 0	0 (0.0 %)	13 (86.7 %)	0 (0.0 %)	13 (86.7 %)
Grade 1	4 (26.7 %)	2 (13.3 %)	0 (0.0 %)	2 (13.3 %)
Grade 2	7 (46.7 %)	0 (0.0 %)	5 (33.3 %)	0 (0.0 %)
Grade 3	2 (13.3 %)	0 (0.0 %)	9 (60.0 %)	0 (0.0 %)
Grade 4	2 (13.3 %)	0 (0.0 %)	1 (6.7 %)	0 (0.0 %)

^* Ocular motility limitation was divided into 5 grades, where 0 means no limitation and each increment reflects a 25% reduction of ocular movement compared to unaffected side. (1=less than 25%; 2=between 25 and 50%; 3=between 50 and 75%; 4=more than 75% of limitation)

^† Diplopia was graded with the same increment system. (0=no diplopia; 1=diplopia seen at over 60 degree from primary gaze; 2=over than 45 degree; 3=over than 30 degree; 4=less than 30 degree)

Table 4.

The number of cases showing complications after reconstruction of orbital wall fracture with Macropore^® orbital floor liner

Complication	Case / Patients
Infection	0 / 35
Dislocation of implant	0 / 35
Loss of vision	0 / 35
Limitation of motion or diplopia	0 / 20^*

^* Patients who showed no limitation of ocular motion or diplopia preoperatively.

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