Analysis of the effect of repair materials for orbital blowout fracture on complications

Management of Orbital Floor Fractures: Our Experience in 10 Years

Purpose

Orbital floor Fractures are the most common fractures involving the facial skeleton and usually occurs after traumatic events. The reconstruction of the orbital floor can be performed with different biocompatible materials. The aim of our retrospective study is to analyze the short- and long-term outcomes of surgically treated patients based on the material used to repair the orbital floor.

Methods

We enrolled 146 patients hospitalized for orbital floor fractures in the Maxillofacial Surgery Unit of the Federico II University of Naples from 1 to 2010 to July 2020. All the fractured orbital floors were reconstructed with non-resorbable (Titanium Mesh, SynPor, SuPor and MedPor implants) or resorbable (collagen membrane, bovinum pericardium membrane, autologous bone graft) materials.

Results

We utilized non-resorbable materials in 56% (82 cases) and resorbable implants in 44% (64 cases). An improvement of the preoperative symptomatology and an aesthetical good outcome was achieved in most cases.

Conclusions

Data obtained supports that both resorbable and non-resorbable materials for orbital floor reconstruction are a safe and effective alternatives and offer satisfactory results in functional and aesthetic evaluations.

Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners

Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.

Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta-analysis

BACKGROUND

The aim of this network meta-analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials.

METHODS

PubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications.

RESULTS

Nine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l-lactic acid and dl-lactic acid (P[L/DL]LA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts.

CONCLUSION

P(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.