Abstract
Purpose To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings. Methods A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients' demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed. Results All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm (P < 0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured. Conclusions This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.
Highlights
Orbital blowout fractures are common and may occur in isolation or as part of a more complex facial fracture
Medical records obtained included patient age, gender, mechanism of initial injury, orbital fracture location, implants used in previous surgery, complications after primary surgery or indication for secondary surgery, implant used in secondary repair, and interval between primary and secondary surgery
E decision for secondary repair was based on clinical presentation correlated with radiographic findings, such as a malpositioned or absent orbital implant [6]
Summary
Orbital blowout fractures are common and may occur in isolation or as part of a more complex facial fracture. Reconstruction requires orbital defect assessment and accurate restoration of orbital volume to prevent undesired outcomes of enophthalmos or diplopia [1]. Several publications on the subject of secondary orbital and periorbital fracture repairs did not involve prior surgical repair of medial or orbital floor walls [2, 3] or did not discuss the challenges and techniques of performing secondary revision surgery by removal of the implant or placement of new implants above a malpositioned implant [4, 5]. Inadequate primary orbital repair causing functional defects and cosmetic deficits is a great challenge for those surgeons who decide to perform secondary reconstruction surgery. Scarring accompanying the primary incision and fibrosis in response to implanted orbital materials increase the risks of complications associated with secondary surgery [6]. If secondary surgery is performed, it can substantially improve patients’ quality of life
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