Orbital Floor Fracture Repair

Abstract

Archives of Facial Plastic SurgeryVol. 9, No. 4 Editor's Correspondence: Comments and OpinionsFree AccessOrbital Floor Fracture RepairRhodri Williams and Sat ParmarRhodri WilliamsCorrespondence: Dr Williams, Department of Oral and Maxillofacial Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH England E-mail Address: rhodri.williams@uhb.nhs.ukSearch for more papers by this author and Sat ParmarSearch for more papers by this authorPublished Online:1 Jul 2007https://doi.org/10.1001/archfaci.9.4.300AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In response to the research letter by Majmundar and Hamilton,1 we would like to highlight some limitations of their article. We agree with the authors' ideals for implantable material for reconstruction of orbital fractures and that it should be easily shaped, but we would add that the material should also have the ability to retain its molded shape. SupraFOIL material (S. Jackson Inc, Alexandria, Virginia) will not retain its new shape, unlike some other materials, such as reinforced polyethylene (MEDPOR TITAN; Porex Surgical Products Inc, Newnan, Georgia) and titanium mesh. The cost argument is valid for all health equipment and interventions, but the material must be appropriate for the purpose for which it was intended.The conclusions that the authors make with regard to the low complication rate associated with this material cannot be wholly justified given their small sample size and relatively short follow-up period. Indeed, the only other articles2,3 quoted regarding the use of this material for this purpose, reported its use in only 2 and 12 patients, respectively. This is in contrast to some of the articles in the literature reporting the use of Silastic (Dow Corning, Midland, Michigan),4 polyethylene,5 and titanium.6In addition, the computed tomographic images the authors provide show a lack of anatomical correction of the orbital floor, which is likely to result in increased orbital volume and hence measurable enophthalmos. This complication would not necessarily have been identified with a simple telephone review with the patient.Although we understand that attempts to perform and publish research in this difficult area are laudable, we do not feel that enough scientific rigor has been applied to the methods of this article and its review. It may well be true that this material is a cost-effective and safe method for treating this condition, but the evidence shown in this article does not support that conclusion. A larger, more robust study is required.