The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review.

Akash Sivam,Natalie Enninghorst

doi:10.3390/medicines9010006

Abstract

The aim of this study is to present a narrative review of the properties of materials currently used for orbital floor reconstruction. Orbital floor fractures, due to their complex anatomy, physiology, and aesthetic concerns, pose complexities regarding management. Since the 1950s, a myriad of materials has been used to reconstruct orbital floor fractures. This narrative review synthesises the findings of literature retrieved from search of PubMed, Web of Science, and Google Scholar databases. This narrative review was conducted of 66 studies on reconstructive materials. Ideal material properties are that they are resorbable, osteoconductive, resistant to infection, minimally reactive, do not induce capsule formation, allow for bony ingrowth, are cheap, and readily available. Autologous implants provide reliable, lifelong, and biocompatible material choices. Allogenic materials pose a threat of catastrophic disease transmission. Newer alloplastic materials have gained popularity. Consideration must be made when deliberating the use of permanent alloplastic materials that are a foreign body with potential body interactions, or the use of resorbable alloplastic materials failing to provide adequate support for orbital contents. It is vital that surgeons have an appropriate knowledge of materials so that they are used appropriately and reduce the risks of complications.

Highlights

Orbital floor fractures were first recognised and described in 1844 by MacKenzie and Lang [1]
Even with proper surgical technique, successful anatomical reconstruction and appropriate follow-up complications such as enophthalmos, diplopia resulting from extraocular muscle dysfunction, and infraorbital nerve hypesthesia are frequently seen during long-term follow-up [11,13]
The search was performed on PubMed (Medline), Web of Science and Google Scholar to obtain evidence supporting materials used for orbital floor reconstruction until January 2021

Summary

Introduction

Orbital floor fractures were first recognised and described in 1844 by MacKenzie and Lang [1]. In 1957, Smith and Regan described orbital fractures as fractures resulting from a sudden increase in hydraulic pressure [2] This impact is transmitted to periocular structures, resulting in pressure to the orbit that fractures the orbital floor, commonly in the posteromedial region, parallel to the infraorbital nerve where the bone is the thinnest [2,3]. This blow can be directly to the globe or to the inferior orbital rim, causing the floor to buckle [2,4]. Even with proper surgical technique, successful anatomical reconstruction and appropriate follow-up complications such as enophthalmos, diplopia resulting from extraocular muscle dysfunction, and infraorbital nerve hypesthesia are frequently seen during long-term follow-up [11,13]

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