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Wraparound nylon foil implant for isolated orbital floor fractures. Am J Otolaryngol 2022; 43:103229. [PMID: 34537506 DOI: 10.1016/j.amjoto.2021.103229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE There are a variety of implant materials available for orbital floor fracture repair. Implant selection is guided by surgeon experience, availability, and patient specific needs. The purpose of this study is to describe a "wraparound" technique for nylon foil implant placement for large, isolated floor fractures that provides excellent results with low incidence of enophthalmos or other complications. MATERIALS AND METHODS A retrospective chart review from 2012 to 2020 was conducted in patients who underwent isolated orbital floor fracture repair with the use of the "wraparound" nylon foil implant. The surgical technique is described. Preoperative CT scans were assessed, and the patients were divided into groups based on the size of the floor fracture. Postoperative data was collected including Hertel measurements and complications related to the implant. RESULTS There were eighty patients who underwent orbital floor fracture repair with the described technique and had adequate follow-up. There were 18 (22.5%) small-sized fractures, 32 (40%) medium-sized fractures, and 30 (37.5%) large-sized fractures in the study group. One patient (3.33%) in the large fracture group had clinically significant enophthalmos of 2 mm postoperatively. There were no other patients with clinically significant enophthalmos. There were no instances of any complications related to the implant, and no patients required implant removal. CONCLUSIONS The "wraparound" technique for a nylon foil implant provides excellent results for isolated orbital floor fractures. It provides more support and stability than traditional nylon implants for larger fractures and has minimal complication rates.
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Gupta S, Mehrotra D, Singh PK, U V, Bhave S, Katrolia R. Quality of life after reconstruction of traumatic orbital floor defects using titanium mesh and medpore: A randomised controlled trial. J Oral Biol Craniofac Res 2021; 11:200-203. [PMID: 33665067 PMCID: PMC7897992 DOI: 10.1016/j.jobcr.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022] Open
Abstract
AIM AND OBJECTIVES The aim of this study was to analyse the outcomes of orbital floor reconstruction with two types of orbital implants and assess patients' quality of life. MATERIAL AND METHODS 39 sequential patients with clinical and radiological evidence of orbital floor fracture, presenting diplopia, enophthalmos, paraesthesia or a post traumatic residual orbital deformity were included in this study and randomised for orbital floor reconstruction using porous polyethylene sheet (Biopore™) or preshaped titanium mesh on a 3D model. Their pre and postoperative quality of life were compared. Success rate was assessed and scored with a minimum of zero (none) and a maximum of ten (excellent) for improvement in the signs of diplopia, enophthalmos, hypoglobus, paraesthesia and aesthetics. RESULTS Both QOL scores and Success score was greater in cases which reconstruction of orbital floor was performed with preshaped titanium mesh as compared to those with Biopore™. CONCLUSION Preshaped titanium mesh shows better results than reconstruction with Biopore™. However a large sample size and a long term follow up is needed for generating the best evidence. Quality of life extensively improves after orbital floor reconstruction motivating the patients desire to live.
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Affiliation(s)
- Sneha Gupta
- Dept of Oral & Maxillofacial Surgery, King George’s Medical University, Lucknow, 226003, India
| | - Divya Mehrotra
- Dept of Oral & Maxillofacial Surgery, King George’s Medical University, Lucknow, 226003, India
| | - Praveen Kumar Singh
- Dept of Oral & Maxillofacial Surgery, King George’s Medical University, Lucknow, 226003, India
| | - Vignesh U
- Dept of Oral & Maxillofacial Surgery, King George’s Medical University, Lucknow, 226003, India
| | - Sujay Bhave
- Dept of Oral & Maxillofacial Surgery, King George’s Medical University, Lucknow, 226003, India
| | - Ravi Katrolia
- Dept of Oral & Maxillofacial Surgery, King George’s Medical University, Lucknow, 226003, India
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Ocular motility and diplopia measurements following orbital floor fracture repair. Am J Otolaryngol 2021; 42:102879. [PMID: 33429179 DOI: 10.1016/j.amjoto.2020.102879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Diplopia and ocular motility restriction following orbital fracture repair are common complications. The reported rates in the literature differ greatly, in part due to varying definitions of diplopia and methods of measurement. The purpose of this study is to describe a practical and efficient in-office method for examining ocular motility and diplopia in orbital trauma patients and to report the outcomes in a series of patients who underwent orbital floor fracture repair. MATERIALS AND METHODS A retrospective chart review from 2012 to 2019 was conducted in patients who underwent isolated orbital floor fracture repair within 3 weeks of trauma. All patients had examinations to assess extraocular motility and subjective diplopia using the described techniques. RESULTS Ninety-three patients underwent orbital floor fracture repair and had adequate follow-up. Preoperatively, 71 (76%) patients had some restriction in motility and 59 (63%) patients complained of diplopia. Postoperatively, only 1 patient (1.09%) had clinically significant diplopia. Five (5.4%) additional patients demonstrated mild restriction in supraduction upon detailed ophthalmic examination that was not discovered upon subjective history. No patients had worsening of diplopia or motility after surgery. CONCLUSIONS Diplopia and motility restriction following orbital fracture repair can be a persistent problem for some patients. It is important to perform a careful ophthalmic examination to detect motility deficits and diplopia that can be significant to the patient. The true rate of restriction and diplopia may be higher using detailed ophthalmic diagnostic techniques compared to subjective patient history.
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Später T, Menger MD, Laschke MW. Vascularization Strategies for Porous Polyethylene Implants. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:29-38. [PMID: 32524897 DOI: 10.1089/ten.teb.2020.0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Porous polyethylene (pPE) is a frequently implanted biomaterial in craniofacial reconstructive surgery. Its rapid vascularization and tissue incorporation are major prerequisites to prevent complications, such as material infection, migration, and extrusion. To achieve this, several sophisticated strategies have been introduced and evaluated during the last 20 years. These include (i) the angiogenic stimulation of the host tissue with epidermal growth factor, basic fibroblast growth factor or macrophage-activating lipopeptide-2, (ii) material modifications, such as increase of surface roughness and incorporation of bioactive glass particles, (iii) surface coatings with growth factors, glycoproteins, acrylic acid, arginine/glycine/aspartic acid peptide as well as components of the plasminogen activation system and autologous clotted blood or serum, and (iv) the seeding with fibroblasts, chondrocytes, stem cells, or adipose-tissue-derived microvascular fragments. The majority of these approaches showed promising results in experimental studies and, thus, may be capable of improving the success rates after pPE implantation in future clinical practice.
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Affiliation(s)
- Thomas Später
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg, Germany
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg, Germany
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Joo JD, Kang DH, Kim HS. Orbital wall restoring surgery with resorbable mesh plate. Arch Craniofac Surg 2018; 19:264-269. [PMID: 30332891 PMCID: PMC6325327 DOI: 10.7181/acfs.2018.01956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/17/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Orbital 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. METHODS A 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. RESULTS The 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. CONCLUSION The 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.
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Affiliation(s)
- Jae Doo Joo
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Korea
| | - Dong Hee Kang
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Korea
| | - Hyon Surk Kim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Korea
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Salmoria GV, Ghizoni GB, Gindri IM, Marques MS, Kanis LA. Hot extrusion of PE/fluorouracil implantable rods for targeted drug delivery in cancer treatment. Polym Bull (Berl) 2018. [DOI: 10.1007/s00289-018-2451-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Khorasani M, Janbaz P, Rayati F. Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study. J Korean Assoc Oral Maxillofac Surg 2018; 44:128-135. [PMID: 29963494 PMCID: PMC6024064 DOI: 10.5125/jkaoms.2018.44.3.128] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/09/2017] [Accepted: 06/25/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives The role of alloplastic materials in maxillofacial reconstruction is still controversial. Determining the utility of porous, high-density, polyethylene implants as a highly stable and flexible, porous alloplast, with properties such as rapid vascularization and tissue ingrowth, is crucial in cases of maxillofacial deformities and aesthetic surgery. Materials and Methods Thirty high-density porous polyethylene implants were implanted in 16 patients that had been referred to a private office over a three-year period. These implants were used for correcting congenital deformities, posttraumatic defects and improving the aesthetic in nasal, paranasal, malar, chin, mandibular angle, body and orbital areas. Results The outcomes of the cases in this study showed good aesthetic and functional results. The majority of patients had no signs of discomfort, rejection or exposure. Two implants suffered complications: a complicated malar implant was managed by antibiotic therapy, and an infected mandibular angle implant was removed despite antibiotic therapy. Conclusion Based on the results, the Medpor implant seems to be an excellent biomaterial for correcting various facial deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. It is strong, flexible and easy to shape.
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Affiliation(s)
- Mansour Khorasani
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Pejman Janbaz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farshid Rayati
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
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Fouad H, AlFotawi R, Alothman OY, Alshammari BA, Alfayez M, Hashem M, Mahmood A. Porous Polyethylene Coated with Functionalized Hydroxyapatite Particles as a Bone Reconstruction Material. MATERIALS 2018; 11:ma11040521. [PMID: 29596358 PMCID: PMC5951367 DOI: 10.3390/ma11040521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
In this study, porous polyethylene scaffolds were examined as bone substitutes in vitro and in vivo in critical-sized calvarial bone defects in transgenic Sprague-Dawley rats. A microscopic examination revealed that the pores appeared to be interconnected across the material, making them suitable for cell growth. The creep recovery behavior of porous polyethylene at different loads indicated that the creep strain had two main portions. In both portions, strain increased with increased applied load and temperature. In terms of the thermographic behavior of the material, remarkable changes in melting temperature and heat fusion were revealed with increased the heating rates. The tensile strength results showed that the material was sensitive to the strain rate and that there was adequate mechanical strength to support cell growth. The in vitro cell culture results showed that human bone marrow mesenchymal stem cells attached to the porous polyethylene scaffold. Calcium sulfate–hydroxyapatite (CS–HA) coating of the scaffold not only improved attachment but also increased the proliferation of human bone marrow mesenchymal stem cells. In vivo, histological analysis showed that the study groups had active bone remodeling at the border of the defect. Bone regeneration at the border was also evident, which confirmed that the polyethylene acted as an osteoconductive bone graft. Furthermore, bone formation inside the pores of the coated polyethylene was also noted, which would enhance the process of osteointegration.
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Affiliation(s)
- H Fouad
- Applied Medical Science Department, Community College, King Saud University, Riyadh 11437, Saudi Arabia.
- Department of Biomedical Engineering, Faculty of Engineering, Helwan University, Helwan 11792, Egypt.
| | - Randa AlFotawi
- Maxillofacial Surgery Department, Dental Faculty, King Saud University, Riyadh 11545, Saudi Arabia.
| | - Othman Y Alothman
- Chemical Engineering Department, King Saud University, Riyadh 11421, Saudi Arabia.
- Deanship of Graduate Studies, Saudi Electronic University, Riyadh 11637, Saudi Arabia.
| | - Basheer A Alshammari
- Material Science Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia.
| | - Musaad Alfayez
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
| | - Mohamed Hashem
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11437, Saudi Arabia.
| | - Amer Mahmood
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
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Is there an ideal implant for orbital reconstructions? Prospective 64-case study. J Craniomaxillofac Surg 2016; 44:1682-1688. [PMID: 27637477 DOI: 10.1016/j.jcms.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/17/2016] [Accepted: 08/08/2016] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to compare the effectiveness of porous polyethylene, titanium mesh, and castor oil-derived biopolymer randomized in orbital reconstructions of defects larger than 1 cm in length on the inferior and medial walls. A total of 63 patients (64 orbits) were evaluated to determine the presence of diplopia, enophthalmos ocular motility, and infraorbital nerve paraesthesia in both the preoperative and postoperative periods. The surgeons' opinions of the ease in handling the implants were also obtained after each procedure. The patients were divided into 3 groups: 17 received porous polyethylene, 21 received castor oil-derived biopolymer, and 26 received titanium mesh. In the preoperative period, 30 patients experienced enophthalmos, 11 experienced diplopia, and 12 experienced ocular motility. Ninety days after the orbital reconstruction, 6 cases of enophthalmos persisted, as did 2 cases of diplopia and 2 cases of ocular motility. Ten patients developed some type of postoperative complication. Material removal was required in only 1 case. Regardless of the size of the defect, the materials used were found to be effective for reconstructing orbital volume; they were also found to offer ease in handling and stabilization.
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Aryasit O, Ng DS, Goh ASC, Woo KI, Kim YD. Delayed onset porous polyethylene implant-related inflammation after orbital blowout fracture repair: four case reports. BMC Ophthalmol 2016; 16:94. [PMID: 27387333 PMCID: PMC4936306 DOI: 10.1186/s12886-016-0287-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Porous polyethylene implants are commonly used in orbital blowout fracture repair because of purported biocompatibility, durability, and low frequency of complications. Delayed inflammation related to porous polyethylene sheet implants is very rare and no case series of this condition have been reported. Case Presentation This is a retrospective review of clinical presentations, radiographic findings, histopathological findings, treatments, and outcomes of patients who developed delayed complications in orbital blowout fracture repair using porous polyethylene sheets. Four male patients were included with a mean age of 49 years (range 35–69 years). Blowout fracture repair was complicated with implant-related inflammation 10 months, 2 years, 3 years, and 8 years after surgery. Chronic and subacute orbital inflammatory signs were noted in two patients and acute fulminant orbital inflammation was found in two patients. Three patients developed peri-implant abscesses and one patient had a soft tissue mass around the implant. All patients underwent implant removal and two of these patients with paranasal sinusitis had sinus surgery. Histopathological findings revealed chronic inflammatory changes with fibrosis, and one patient had foreign body granuloma with culture positive Staphylococcus aureus. Conclusions Delayed complications with porous polyethylene sheets used in orbital blowout fracture repair may occur many years following the initial surgery in immunocompetent patients. Low-grade or fulminant inflammation could complicate blowout fracture repair related with the implant.
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Affiliation(s)
- Orapan Aryasit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Alice S C Goh
- International Specialist Eye Center (ISEC), Kuala Lumpur, Malaysia
| | - Kyung In Woo
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Yoon-Duck Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Zalepugin DY, Maksimkin AV, Tilkunova NA, Chernyshova IV, Senatov FS, Vlasov MI. Preparation of porous ultrahigh-molecular-weight polyethylene using subcritical water. RUSSIAN JOURNAL OF PHYSICAL CHEMISTRY B 2016. [DOI: 10.1134/s1990793115080126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Salmoria G, Cardenuto M, Roesler C, Zepon K, Kanis L. PCL/Ibuprofen Implants Fabricated by Selective Laser Sintering for Orbital Repair. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.procir.2015.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Boyette JR, Pemberton JD, Bonilla-Velez J. Management of orbital fractures: challenges and solutions. Clin Ophthalmol 2015; 9:2127-37. [PMID: 26604678 PMCID: PMC4655944 DOI: 10.2147/opth.s80463] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Many specialists encounter and treat orbital fractures. The management of these fractures is often challenging due to the impact that they can have on vision. Acute treatment involves a thorough clinical examination and management of concomitant ocular injuries. The clinical and radiographic findings for each individual patient must then be analyzed for the need for surgical intervention. Deformity and vision impairment can occur from these injuries, and while surgery is intended to prevent these problems, it can also create them. Therefore, surgical approach and implant selection should be carefully considered. Accurate anatomic reconstruction requires complete assessment of fracture margins and proper implant contouring and positioning. The implementation of new technologies for implant shaping and intraoperative assessment of reconstruction will hopefully lead to improved patient outcomes.
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Affiliation(s)
- Jennings R Boyette
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John D Pemberton
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Sai Krishna D, Soumadip D. Reconstruction of Orbital Floor Fractures with Porous Polyethylene Implants: A Prospective Study. J Maxillofac Oral Surg 2015; 15:300-307. [PMID: 27752198 DOI: 10.1007/s12663-015-0840-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 08/28/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The main aim of our study was to assess and evaluate the efficacy, long standing outcome and infection of porous polyethylene implants in treatment of orbital floor fractures. PATIENT AND METHODS Twelve patients with fractures of orbital floor were included in the study. The cause of fracture was road traffic accident, self fall and cow hit respectively. They also complained of enophthalmos (n = 9), diplopia (n = 3), restricted eye movement (n = 2), impairment of infraorbital nerve (n = 3) and dystopia (n = 6). All the fractures were reconstructed with thin porous polyethylene sheets. RESULTS No implants were extruded and there were no signs of inflammatory reactions against porous polyethylene implant. In all nine patients with pre-op enophthalmos it was corrected post-operatively with p value = 0.000 and was statistically significant; diplopia in one patient was corrected; persistence of double vision was noted in two patients. Restricted eye movement was corrected in all patients, dystopia was corrected in four patients and in two patients have persisting dystopia. Paresthesia persisted in all three patients. CONCLUSION Our experience was that reconstruction of orbital floor fracture using porous polyethylene implant is reliable, safe and effective and may be used for reconstruction of the orbital floor fracture with no donor site morbidity.
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Affiliation(s)
- Degala Sai Krishna
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Bannimantap, Sri Shivarathreeshwara Nagara, Mysore, Karnataka 570015 India
| | - Dey Soumadip
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Bannimantap, Sri Shivarathreeshwara Nagara, Mysore, Karnataka 570015 India
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Koh V, Chiam N, Sundar G. Survey of Common Practices among Oculofacial Surgeons in the Asia-Pacific Region: Management of Orbital Floor Blowout Fractures. Craniomaxillofac Trauma Reconstr 2014; 7:197-202. [PMID: 25136408 PMCID: PMC4130751 DOI: 10.1055/s-0034-1371774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/09/2013] [Indexed: 10/25/2022] Open
Abstract
A web-based anonymous survey was performed to assess common practices of oculofacial surgeons in the management of traumatic orbital floor blowout fractures. A questionnaire which contained questions on several controversial topics in the management of orbital floor fractures was sent out via e-mail to 131 oculofacial surgeons in 14 countries in the Asia-Pacific region. A total response rate of 58.3% was achieved from May to December 2012. The preferred time for surgical intervention was within 2 weeks for adult patients, porous polyethylene implant was the most popular choice, and most surgeons preferred the transconjunctival approach. Postoperatively, diplopia was the most commonly encountered complication and most oculofacial surgeons reviewed their patients regularly for up to 12 months. We report the results of the first survey of oculofacial surgeons within the Asia-Pacific region on the management of orbital floor blowout fractures. Compared with previous surveys (from year 2000 to 2004), the duration to surgical intervention was comparable but there was a contrasting change in preferred surgical approach and choice of orbital implant.
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Affiliation(s)
- Victor Koh
- Department of Ophthalmology, National University Health System, Kent Ridge Road, Singapore
| | - Nathalie Chiam
- Department of Ophthalmology, National University Health System, Kent Ridge Road, Singapore
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Health System, Kent Ridge Road, Singapore
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[When should an orthoptic evaluation be prescribed in the management of orbital floor fracture? A prospective study of 47 fractures]. ACTA ACUST UNITED AC 2014; 115:274-8. [PMID: 25081488 DOI: 10.1016/j.revsto.2014.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/27/2014] [Accepted: 07/10/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We evaluated the indication of orthoptic evaluation for the management of orbital floor fractures in a prospective series. MATERIAL AND METHOD Forty-seven patients presenting with an orbital floor fracture were included in our prospective study. Consultations in orthoptics and maxillo-facial surgery were regularly carried out. Diplopia and motility were systematically assessed as well as a coordimetric examination according to Hess-Lees's technique. RESULTS Nineteen percent of coordimetric motility disorders were observed among asymptomatic patients, after trauma. No diplopia or clinical motility disorder were observed 1 and 2 months after trauma, and coordimetric examinations came back to normal 2 and 3 months after trauma respectively for non-operated (26) and operated (21) patients. CONCLUSIONS An orthoptic evaluation is necessary for the management of orbital floor fractures to diagnose the type of diplopia, motility disorders, and to indicate a coordimetric examination if diplopia is present. We suggest this orthoptic evaluation for patients presenting with diplopia between 5 and 10 days following trauma, 1 month after trauma for non-surgical treatment and 2 months after trauma for surgical treatment.
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Gunarajah DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg 2013; 71:550-70. [PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/10/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults. MATERIALS AND METHODS A systematic search of the English literature was performed in the databases of PubMed, Cochrane Library, and EMBASE. The study selection process was adapted from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, and 55 articles complied with the study inclusion criteria. The primary outcome measures were diplopia, enophthalmos, graft extrusion/displacement, and infection related to the graft material. The secondary outcome measures were infraorbital paresthesia, orbital dystopia, orbital soft tissue entrapment, and donor-site complications. RESULTS Of 55 articles, 41 (74.5%) evaluated were retrospective case series, 9 (16.4%) were retrospective case-control studies, 3 (5.5%) were controlled trials, and 2 (3.6%) were prospective case series. Autogenous graft materials were predominantly used in 19 studies, alloplastic materials were used in 33 studies, and the remaining 3 articles reported on allogeneic materials. Overall, 19 different types of implant materials were used in 2,483 patients. Of 827 patients with diplopia before surgery, 151 (18.3%) had diplopia postoperatively. Of 449 patients with enophthalmos before surgery, 134 (29.8%) had enophthalmos postoperatively. Only 2 patients (0.1%) and 14 patients (0.6%) had graft extrusion/displacement and infection related to the graft material, respectively; alloplastic biomaterials were used in all of these cases. CONCLUSIONS All graft materials used were successful to variable degrees because all studies reported improvement in terms of the recorded outcome measures. A guideline for choice of implant material based on defect size was developed.
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Chambless LB, Mawn LA, Forbes JA, Thompson RC. Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: A novel technique. J Craniomaxillofac Surg 2012; 40:e28-32. [DOI: 10.1016/j.jcms.2011.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/14/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022] Open
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T Tang D, F Lalonde J, H Lalonde D. Delayed Immediate Surgery for Orbital Floor Fractures: Less Can Be More. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2011. [DOI: 10.1177/229255031101900402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Orbital floor fractures can result in diplopia, enophthalmos, hypoglobus and infraorbital dysthesia. Currently, the most common treatment for orbital floor fractures is immediate surgical intervention. However, there are a number of well-documented cases of unoperated orbital floor fractures in the literature, culminating in diplopia or enophthalmos in few patients. of these, none reported the diplopia or enophthalmos to be bothersome. As reported previously in the ophthalmology literature, most orbital floor fracture-induced diplopia resolves as the swelling settles, and the few patients with remaining diplopia can successfully be treated with surgery on the uninvolved eye. It has also been commented that most patients with enophthalmos are asymptomatic. The authors’ institution has more than 50 surgeon-years experience with delaying immediate surgery for two weeks to allow time for the swelling-induced diplopia to resolve. In the authors’ experience, true entrapment of the inferior rectus muscle is rare. The present article describes a study of late follow-up (average 945 days) of 11 nonoperated patients with orbital floor fractures. In the eight patients who initially presented with diplopia, there was resolution of functionally limiting double vision. Only one patient had asymptomatic, but measurably significant, enophthalmos at −3 mm. All patients had full restoration of extraocular movements and resolution of infraorbital dysthesia. None of the patients were exposed to the operative risks of ectropion, infection, implant extrusion, bleeding or blindness. The present study provides level IV evidence that delaying surgery up to two weeks after orbital floor fracture may avoid unnecessary surgical risks and inconveniences in many patients with orbital floor fracture.
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Affiliation(s)
- David T Tang
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick
| | - Jan F Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick
| | - Donald H Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick
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Kashkouli MB, Pakdel F, Sasani L, Hodjat P, Kaghazkanani R, Heirati A. High-density porous polyethylene wedge implant in correction of enophthalmos and hypoglobus in seeing eyes. Orbit 2011; 30:123-30. [PMID: 21574800 DOI: 10.3109/01676830.2011.558971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION To report the results of post-traumatic enophthalmos/hypophthalmos correction with high-density porous polyethylene wedge implants in seeing eyes. METHODS This is an interventional case series of 25 patients (25 eyes) with post-traumatic enophthalmos and hypophthalmos, who underwent orbital reconstruction to correct the enophthalmos and hypophthalmos using Medpor® wedge implant. The aim was an overcorrection of 1 mm in comparison to the other eye, intra-operatively. If needed, trimming of the wedge implant or adding Medpor® sheets were used to achieve the goal. Success was defined as achieving the globe position within 1 mm of the other eye in the last follow-up. Improvement and failure were considered as correction outside the success range of 1 mm and no change in the amount of enophthalmos/hypophthalmos, respectively. RESULTS Patients were followed for at least 6 months (mean= 12.66, SD= 12.32). Success, improvement and failure of enophthalmos correction were: 58.3% (14/24), 37.5% (9/24) and 1 (1/24, 4.1%), respectively. Success, improvement and failure of hypophthalmos correction were 73.68% (14/19), 15.78% (3/19) and 5.26% (1/19), respectively. There was no significant difference between the success rate of enophthalmos versus hypophthalmos correction (P= 0.8). Results of 1-month follow up change in enophthalmos and hypophthalmos significantly correlated (r= 0.92, P= 0.000) with the change recorded at last follow up. CONCLUSIONS Porous polyethylene wedge implants are useful and safe in correction of enophthalmos and hypoglobus in seeing eyes. Appropriately positioned implant yields no significant difference in correction of enophthalmos versus hypophthalmos.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Plastic Surgeries Unit, Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Maier W. Biomaterials in skull base surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 8:Doc07. [PMID: 22073100 PMCID: PMC3199810 DOI: 10.3205/cto000059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reconstruction materials and techniques for the base of the skull have undergone rapid developments and differentiation in recent years. While mostly autotransplants, collagens or resorbable alloplastic materials are preferred for duraplasties, pronounced organ-specific differences can be observed in the reconstruction of hard tissues. The use of polymethylmethacryl bone cement, once wide-spread, has decreased greatly due to the release of toxic monomers. Bony autotransplants are still used primarily for smaller skull-base defects, intraoperatively formable titanium nets may be also used for larger fronto- or laterobasal reconstructions of bony defects. Defects in visible areas are increasingly closed with preformed titanium or ceramic implants, which are planned and fitted to the individual patient using preoperative CT imaging. At the skull base, this applies especially to reconstructions of the frontal sinus. For extensive reconstructions of the orbita, titanium nets and non-resorbable plastics have proven valuable; in closing smaller defects especially of the orbital floor, resorbable implants based on Polyglactin 901 are also used.
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Affiliation(s)
- Wolfgang Maier
- Department of Otorhinolaryngology, University of Freiburg Medical School and Clinics, Freiburg, Germany
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Lee JY, Lee ST, Kim YD, Shin SH, Kim UK, Chung IK, Hwang DS. Orbital roof and supraorbital ridge fracture: a report of three cases. J Korean Assoc Oral Maxillofac Surg 2011. [DOI: 10.5125/jkaoms.2011.37.6.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sung-Tak Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - In-Kyo Chung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Dae-Seok Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
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Gu X, Ding F, Yang Y, Liu J. Construction of tissue engineered nerve grafts and their application in peripheral nerve regeneration. Prog Neurobiol 2010; 93:204-30. [PMID: 21130136 DOI: 10.1016/j.pneurobio.2010.11.002] [Citation(s) in RCA: 416] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 11/02/2010] [Accepted: 11/23/2010] [Indexed: 01/01/2023]
Abstract
Surgical repair of severe peripheral nerve injuries represents not only a pressing medical need, but also a great clinical challenge. Autologous nerve grafting remains a golden standard for bridging an extended gap in transected nerves. The formidable limitations related to this approach, however, have evoked the development of tissue engineered nerve grafts as a promising alternative to autologous nerve grafts. A tissue engineered nerve graft is typically constructed through a combination of a neural scaffold and a variety of cellular and molecular components. The initial and basic structure of the neural scaffold that serves to provide mechanical guidance and optimal environment for nerve regeneration was a single hollow nerve guidance conduit. Later there have been several improvements to the basic structure, especially introduction of physical fillers into the lumen of a hollow nerve guidance conduit. Up to now, a diverse array of biomaterials, either of natural or of synthetic origin, together with well-defined fabrication techniques, has been employed to prepare neural scaffolds with different structures and properties. Meanwhile different types of support cells and/or growth factors have been incorporated into the neural scaffold, producing unique biochemical effects on nerve regeneration and function restoration. This review attempts to summarize different nerve grafts used for peripheral nerve repair, to highlight various basic components of tissue engineered nerve grafts in terms of their structures, features, and nerve regeneration-promoting actions, and finally to discuss current clinical applications and future perspectives of tissue engineered nerve grafts.
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Affiliation(s)
- Xiaosong Gu
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, 19 Qixiu Road, Nantong, JS 226001, PR China.
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Prowse SJ, Hold PM, Gilmour RF, Pratap U, Mah E, Kimble FW. Orbital floor reconstruction: A case for silicone. A 12 year experience. J Plast Reconstr Aesthet Surg 2010; 63:1105-9. [DOI: 10.1016/j.bjps.2009.05.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Tabrizi R, Ozkan TB, Mohammadinejad C, Minaee N. Orbital Floor Reconstruction. J Craniofac Surg 2010; 21:1142-6. [DOI: 10.1097/scs.0b013e3181e57241] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ram H, Singh RK, Mohammad S, Gupta AK. Efficacy of Iliac Crest vs. Medpor in Orbital Floor Reconstruction. J Maxillofac Oral Surg 2010; 9:134-41. [PMID: 22190772 PMCID: PMC3244104 DOI: 10.1007/s12663-010-0047-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022] Open
Abstract
AIM The present study is to compare the effectiveness of iliac crest graft and medpor implant, for repairing traumatic orbital floor defects. MATERIALS AND METHODS A total of 20 patients were included in the study. Autogenous iliac crest graft and medpor implant was used in 10 patients of the each group. Patients were evaluated for the presence or absence of diplopia, enophthalmos, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8 mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. RESULTS All patients were successfully treated by restoration of the orbital wall continuity. Follow-up was done at 1-12 weeks. One patient had postoperative infection. There was no graft extrusion. CONCLUSIONS Both the groups showed satisfactory results, but group II was better than group I, as there was no donor site morbidity. Porous polyethylene (Medpor) is a biocompatible and high-density polyethylene implant. It is well tolerated by surrounding tissue, and its porous structure is rapidly infiltrated by host tissue. It is a highly stable and somewhat flexible porous alloplast that has rapid tissue in growth into its pores.
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Affiliation(s)
- Hari Ram
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - R. K. Singh
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - Anup Kumar Gupta
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
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Abstract
We describe herein a new technique for reconstruction of the orbital floor, using autologous nasal septal bone and report the surgical results achieved in maxillofacial trauma patients.Prior to its clinical surgical application, a cadaver practice was carried out on 5 formalin-fixed adult human cadavers to establish the feasibility and efficacy of the method. Fifteen patients with orbital floor fractures, operated between 2005 and 2008, using this technique, were included in the current study.Cadaveric practice revealed that an adequate and appropriate size of septal bone graft can be harvested for reconstruction of the orbital floor. All patients except one had satisfactory clinical and radiologic late results. One patient experienced persistent enophthalmos, possibly due to delayed repair and associated displaced zygomatic bone fracture.Autologous nasal septal bone as an orbital floor bone graft has many advantages, including low donor site morbidity, adequacy and appropriateness of size, and similarity of its bicortical morphology and histologic nature compared with the orbital floor bone. Our clinical results strongly support that this technique can become a satisfactory alternative to existing reconstruction methods.
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Shetty P, Senthil Kumar G, Baliga M, Uppal N. Options in orbital floor reconstruction in blowout fractures: a review of ten cases. J Maxillofac Oral Surg 2009; 8:137-40. [PMID: 23139492 DOI: 10.1007/s12663-009-0034-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 05/20/2009] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this case series was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with calvarial bone graft, titanium mesh or prolene mesh. METHODS Ten cases of orbital blowout fractures treated at our centre from October 2006 to July 2008 were considered for this study. Clinical examination, patient satisfaction and radiographic investigations were used to assess repaired fractures. RESULTS Prolene mesh was used in four cases, titanium mesh was used in four cases and calvarial graft used in two cases. Nine patients had significant improvement in their esthetic appearance. Symmetry was restored in all cases. All ten cases had a noticeable improvement in the function. Of total ten cases six had diplopia, three recovered completely during the six months after the surgery. Three cases showed improvement later. All ten cases with enopthalmos recovered completely. Of the nine patients with infraorbital numbness, all recovered completely during the six months following surgery. One patient where the reconstruction was done with calvarial bone graft showed mild discrepancy in the ocular level. CONCLUSION For small, linear defects measuring less than 2cm with enopthalmos and restricted ocular movements, prolene mesh (four cases) was used. For larger defects and impure blowout fractures involving the infraorbital rim, calvarial graft (two cases) or titanium mesh (four cases) was used. The outcome of surgery with all three materials was satisfactory. No postoperative complications were seen except for mild hypoglobus in a case reconstructed with calvarial graft. All three materials, calvarial graft, titanium mesh, prolene mesh, have the potential to be useful reconstructive materials in orbital floor blowout fractures.
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Affiliation(s)
- Premalatha Shetty
- Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, India
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Multiple fractures involving the orbit and incidental finding of large fourth ventricular epidermoid. J Craniofac Surg 2009; 20:261-2. [PMID: 19165044 DOI: 10.1097/scs.0b013e318184339b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Epidermoid tumors located in the fourth ventricle are exceedingly rare, and the patients usually present with headaches, vertigo, and/or disequilibrium. We discuss the management of orbital floor and lateral wall fracture in a patient who was also incidentally diagnosed to have a large fourth ventricular epidermoid cyst. Although because of their availability and ease of use many allografts have been described, when available, the use of similar membranous bone of equivalent thickness makes the bone graft ideally suited for reconstruction of the orbital floor.
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Jia-jie X, Li T, Xiao-lei J, Ying J, Jian-jian L, Bo Z. Porous Polyethylene Implants in Orbital Blow-Out Fractures and Enophthalmos Reconstruction. J Craniofac Surg 2009; 20:918-20. [PMID: 19480046 DOI: 10.1097/scs.0b013e3181a2d728] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Current world literature. Curr Opin Ophthalmol 2008; 19:435-43. [PMID: 18772678 DOI: 10.1097/icu.0b013e32830d5da2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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