Abstract
Objective: Titanium mesh is a commonly used material for the reconstruction of orbital floor fractures. However, in some instances, a subsequent inflammatory reaction can occur that causes the adhesion of orbital tissue to the titanium mesh. The adhesion of the orbital soft tissue to the mesh causes diplopia, lid rigidity and extraocular movements restriction. This study was performed to determine if the placement of a collagen membrane over a titanium mesh can prevent the adhesion of orbital soft tissue for an improved clinical outcome. Clinical considerations: A case study was performed investigating 106 patients undergoing a periorbital restoration. Seventy-two patients received a titanium mesh without a barrier membrane, 12 patients received a barrier membrane composed of autologous auricular cartilage to provide a barrier function and 22 patients received a pericardium collagen membrane and titanium mesh. Conclusions: Titanium has been shown to generate an intense inflammatory reaction in host tissues, which can cause fibrosis to adjacent structures. Fibrosis is an essential factor in the repair of fracture sites, however this can lead to adverse effects in the orbital socket. Fibrosis can cause cicatrization and lower eyelid retraction when induced along the lower orbital rim. An improved outcome can be achieved by using a barrier between the titanium mesh and the soft tissue, such as autogenous auricular cartilage, however, only patients treated with a resorbable collagen membrane to act as a soft tissue barricade during site regeneration, prevented the fibrosis reaction and related problems from occurring.
Highlights
Orbital floor fractures can occur following blunt force trauma to the eye socket, most commonly caused by sports injuries, traffic accidents and physical assault
In this paper we present a “periorbital patch” technique that allows grafting of fat and perifascial areolar tissue by means of titanium meshes in a combination with a commercial pericardium-based collagen barrier membrane (Jason® Membrane, Botiss Biomaterials GmbH, Zossen, Germany), originally intended for guided bone regeneration in oral surgeries
In the first four patients, the membrane was stitched to the titanium mesh mesh in order to cover the defect at the point of rupture as the anterior part of the mesh remained uncovered in order to cover the defect at the point of rupture as the anterior part of the mesh remained
Summary
Orbital floor fractures can occur following blunt force trauma to the eye socket, most commonly caused by sports injuries, traffic accidents and physical assault. Some of these symptoms can persist, for example, persistence of diplopia and movement limitation after surgical interventions are reported in up to 20% of the treated cases [2,3]. These issues can be caused by muscle or periorbital soft tissue entrapment in the fracture line, muscle injury or soft tissue adherence to the supporting periorbital implant [4]
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