Treatment of Orbital Fractures with Orbital-Wall Defects using Anatomically Preformed Orbital Wall Reconstruction Plate System

Abstract

This retrospective study evaluated the utility of an orbital wall reconstruction plate system for orbital fractures with relatively large orbital-wall defects. We analyzed the clinical and radiological data of seven patients with orbital fractures. All of the patients suffered midfacial trauma with fractures extending to the orbit. Ophthalmologists diagnosed functional eye complications, including diplopia, enophthalmos, restricted eyeball mobility, and reduced globe motility. The fractures with orbital-wall defects were located in the orbital floor in four (57.1%) and the floor/medial wall in three (42.9%). A 0.4-mm-thick orbital wall reconstruction plate (anatomically preformed titanium mesh plate system) was used for orbital reconstruction together with midfacial fracture reduction with stable internal fixation at the inferior orbital rim. The fractures were assessed preoperatively using computed tomography (CT). The accuracy of the three-dimensional (3D) reconstructed orbital volume with the correct positioning of the anatomically preformed titanium mesh plate system was assessed postoperatively with CT. All of the patients had satisfactory clinical results with no complications associated with this system and the open reduction and internal fixation. There was full recovery of ophthalmological function and active eyeball mobility, without enophthalmos or diplopia. The postoperative CT data showed that the injured orbits had been corrected anatomically based on a precise postoperative 3D volume reconstruction using this system. There was no significant difference compared with the uninjured orbital 3D volume. In conclusion, the reconstruction of orbital wall fractures related to midfacial factures with the anatomically preformed titanium mesh plate system for the orbital reconstruction is a promising surgical technique.