Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene-Titanium Implants

Efficacy of Nasal Septal Complex in the Endoscopic Reconstruction of Medial Orbital Wall

The aim of this study is to investigate the efficacy of nasal septal complex reconstructing the medial orbital wall under some specific circumstances. The authors performed a study that included 10 patients who underwent isolated medial orbital wall fracture (blow-out fracture). All the reconstruction surgery of the patient included in this study fixed defect of medial orbital wall using autologous nasal septal complex (composed of nasal septal cartilage and perpendicular plate of ethmoid). The authors observed postoperative improvements of diplopia or ocular motility disorders of the affected orbit. The surgeries had gained satisfactory results, and without severe postoperative complications. After long-term follow-up, postoperative CT indicated the implant-covered defect of medial orbital wall, and there's no incarceration of the medial rectus. Meanwhile, the authors found there is no crack in the implant, and the surgery using nasal septal complex achieved premorbid orbital form. Autologous nasal septal complex provides a better complement to endoscopic reconstruction of medial orbital wall; this strategy allows nasal septum to reconstruct isolated medial orbital wall defects of various degrees, such as nasal septum fracture and dysplasia of perpendicular plate of ethmoid.

The Use of Functional Biomaterials in Aesthetic and Functional Restoration in Orbital Surgery

The integration of functional biomaterials in oculoplastic and orbital surgery is a pivotal area where material science and clinical practice converge. This review, encompassing primary research from 2015 to 2023, delves into the use of biomaterials in two key areas: the reconstruction of orbital floor fractures and the development of implants and prostheses for anophthalmic sockets post-eye removal. The discussion begins with an analysis of orbital floor injuries, including their pathophysiology and treatment modalities. It is noted that titanium mesh remains the gold standard for orbital floor repair due to its effectiveness. The review then examines the array of materials used for orbital implants and prostheses, highlighting the dependence on surgeon preference and experience, as there are currently no definitive guidelines. While recent innovations in biomaterials show promise, the review underscores the need for more clinical data before these new materials can be widely adopted in clinical settings. The review advocates for an interdisciplinary approach in orbital surgery, emphasizing patient-centered care and the potential of biomaterials to significantly enhance patient outcomes.

Efficacy and Safety of Expanded Polytetrafluoroethylene Implantation in the Correction of Long-Term Posttraumatic Enophthalmos

SUMMARY

Long-term enophthalmos is a common orbital fracture sequela. Various autografts and alloplastic materials have been studied in posttraumatic enophthalmos repair. However, expanded polytetrafluoroethylene (ePTFE) implantation in late enophthalmos repair has rarely been reported. The authors report novel use of ePTFE for late posttraumatic enophthalmos repair. This retrospective study included patients with posttraumatic long-term enophthalmos who underwent hand-carved ePTFE intraorbital implantation for enophthalmos correction. Computed tomography data were collected preoperatively and at follow-up. The volume of ePTFE, the degree of proptosis (DP), and enophthalmos were measured. Postoperative and preoperative DP and enophthalmos were compared using the paired t test. The correlation between ePTFE volume and DP increment was established using linear regression. Complications were identified by chart review. From 2014 to 2021, 32 patients were included, with a mean follow-up of 19.59 months. The mean volume of implanted ePTFE was 2.39 ± 0.89 mL. After surgery, the DP of the affected globe improved significantly, from 12.75 ± 2.12 mm to 15.06 ± 2.50 mm ( P < 0.0001). A significant linear correlation was found between ePTFE volume and DP increment ( P < 0.0001). Enophthalmos was substantially ameliorated from 3.35 ± 1.89 mm to 1.09 ± 2.07 mm ( P < 0.0001). Twenty-five patients (78.23%) had postoperative enophthalmos of less than 2 mm. Infection and implant dislocation were not observed. The authors concluded that ePTFE intraorbital implantation exhibited long-term efficacy and safety for late posttraumatic enophthalmos repair and represents an effective and predictable alternative.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Reconstruction of Medial Orbital Wall Using Autologous Perpendicular Plate of Ethmoid

The aim of this study is to investigate the feasibility of perpendicular plate of ethmoid as material for the reconstruction of medial orbital wall. The main outcome measurement was preoperative and postoperative orbital volume. The authors performed a study including 17 patients who have isolated medial orbital wall fracture (blow-out fracture). All the patients were fixed the defect using autologous perpendicular plate of ethmoid under endonasal approach. The authors compared the preoperative and postoperative orbital volume difference (unaffected orbit, affected orbit) of all the patients, and observed the improvement of diplopia or ocular motility disorders after operation. All 17 medial orbital wall reconstruction surgeries were successful with no severe postoperative ophthalmic complications. Statistically significant differences were found between the preoperative and postoperative orbital tissue volumes for the affected orbit. There was no statistically significant difference found between the tissue volume of the contralateral unaffected orbit and the affected orbit after reconstruction. And postoperative computed tomography showed the implant is in place and there is no medial rectus incarceration. Autologous perpendicular plate of ethmoid proved to be safe and effective in the reconstruction of medial orbital wall under endonasal approach with cost-effectivence, low complication rate, high biocompatibility, and minimally invasion.

The Usefulness of the Navigation System to Reconstruct Orbital Wall Fractures Involving Inferomedial Orbital Strut

BACKGROUND

Little attention has been paid to combined orbital floor and medial wall fractures with the involvement of the inferomedial orbital strut. Managing this particular fracture can prove challenging. However, various innovative techniques have been introduced to assist with the process. Our study focuses on sharing our approach to orbital wall reconstruction using navigation guidance and titanium-reinforced porous polyethylene plates, specifically cases involving the inferomedial orbital strut. We believe that implementing a navigation system can effectively lead surgeons to the fracture site with utmost safety. Also, we hypothesized that this navigation system is beneficial to use singe fan titanium-reinforced porous polyethylene plates with orbital wall fractures involving IOS while minimizing possible complications.

METHODS

We retrospectively reviewed 131 patients with medial orbital wall and orbital floor fractures with or without combined other facial bone fractures who underwent orbital wall reconstruction by a single surgeon from May 2021 to May 2023. Amongst, we identified fourteen orbital wall fractures involving the inferomedial orbital strut. We used a subciliary incision as the only approach method for performing titanium-reinforced porous polyethylene plates for navigation-guided orbital wall reconstruction. Patients were followed up for at least three months.

RESULTS

All cases were effectively resolved using titanium-reinforced porous polyethylene plates. There were no complications during the patient's complete recovery, confirmed clinically and radiologically. Based on the serial CT results, it was discovered that implanted titanium-reinforced porous polyethylene plates successfully covered the defect.

CONCLUSION

Based on our retrospective analysis, it has been determined that among the 131 recorded cases of orbital fractures, 14 of them (or 10.7%) involved the inferomedial orbital strut. Navigation-guided reduction using titanium-reinforced porous polyethylene (TR-PPE) plates can lead to predictable, reliable, and excellent outcomes for treating orbital fractures involving the inferomedial orbital strut without complications.

Biocompatible Materials for Orbital Wall Reconstruction-An Overview

The reconstruction of an orbit after complex craniofacial fractures can be extremely demanding. For satisfactory functional and aesthetic results, it is necessary to restore the orbital walls and the craniofacial skeleton using various types of materials. The reconstruction materials can be divided into autografts (bone or cartilage tissue) or allografts (metals, ceramics, or plastic materials, and combinations of these materials). Over time, different types of materials have been used, considering characteristics such as their stability, biocompatibility, cost, safety, and intraoperative flexibility. Although the ideal material for orbital reconstruction could not be unanimously identified, much progress has been achieved in recent years. In this article, we summarise the advantages and disadvantages of each category of reconstruction materials. We also provide an update on improvements in material properties through various modern processing techniques. Good results in reconstructive surgery of the orbit require both material and technological innovations.

Do Orbital Implants Differ in Complication Rates: A Retrospective Study of 88 Patients, and an Argument for Cost-Effective Practices in the Face of Rising Health Care Costs

Operative repair of orbital fractures utilizes implants constructed of a plethora of materials that vary in cost. Surgeon preference as well as fracture complexity may dictate the implant chosen. In this study, we retrospectively compared the complication rates of the four most common types of implants utilized at our institution. We found no significant difference in complication rates in our sample of 88 patients. Additionally, the least expensive implant was as effective as the most expensive implant in addressing isolated orbital blowout fractures. This situation is not unique to the field of oculoplastics. As evidenced from published literature in other areas of surgery, from orthopaedics to orthodontics, cheaper alternatives often afford similar outcomes as more expensive options. We herein argue that a cost-effective approach should be considered while still allowing for high quality of care, in the face of rising health care costs and health disparities in America.