Comparison of titanium mesh versus polycaprolactone-tricalcium phosphate implant in orbital fracture reconstruction

Abstract

Background: Controversy exists regarding the choice of implant material for orbital floor reconstructions. This study aims to compare the effectiveness of titanium mesh and polycaprolactone-tricalcium phosphate (PCL/TCP) implant for repairing traumatic orbital fractures. Methods: A total of 19 patients with orbital floor reconstructions operated at the National University Health System, Singapore were included in this prospective study between November 2010 and June 2013. Titanium mesh was used in 10 patients, while PCL/TCP implant was used in the other nine patients. Patients were evaluated for the worsening of visual acuity, presence or absence of infraorbital nerve paraesthesia, extraocular muscle function, enophthalmos and diplopia. Postoperative complications such as infection, early resorption, extrusion and persistent pain were also recorded. Results: Restoration of orbital wall continuity was successful in all patients. Follow-up duration was at least one year. There was no statistically significant difference in worsening of visual acuity, presence or absence of infraorbital nerve paraesthesia, extraocular muscle function and enophthalmos. Even though there was no statistically significant difference in diplopia between the two treatment groups preoperatively, there were more patients who had diplopia following titanium mesh postoperatively (P < 0.05). One patient had persistent diplopia, enopthalmos and lateral rectus muscle dysfunction postoperatively, but declined further corrective surgery. There was no infection, early resorption, extrusion or persistent pain. Conclusions: Both groups showed satisfactory results. PCL/TCP composite can be used to fabricate biodegradable fixators for the reconstruction of orbital wall fractures.