Using Titanium Mesh or Micromesh Plates to Reconstruct Complicated Orbital Blowout Fractures

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Complicated orbital blowout fractures, which have either large floor fractures or multi-wall fractures, are difficult to reconstruct with traditional soft implants such as silastic implants. In such situations, rigid but malleable implants are required, so that they can uphold the whole weight of the orbital tissue, reduce the enlarged orbital volume, be shaped to cover the multi-wall defects, and be easier to fixate. Titanium mesh and micromesh plates were used to reconstruct 7 cases of complicated blowout fractures. There were 5 males and 2 females, average age 30.5years old. Six cases had large orbital floor fractures in combination with medial wall fractures. Three cases also had lateral walls and zygomaticomaxillary complex (ZMC) fractures. Only one case had fractures in the posterior part of the medial wall and a small part of the floor. All cases had enophthalmos of more than 2mm. Six cases had severe limitations in eyeball duction. One case with mostly medial wall fractures had diplopia only at the extreme right lateral gaze. Six cases were operated on from 6 weeks to 8 months after their injuries were incurred. In the operation, the fracture defects were reconstructed with titanium plates after complete release of the herniated tissues. The titanium plates could be easily shaped and contoured to cover all the large defect areas. Rigid plates can also be securely fixed so that the entire orbital contents can be upheld. After a mean follow-up of 16.1 months, the enophthalmos of the 4 patients without eviscerations were corrected back to less than 2mm. Three cases with eviscerations and intraocular implants were satisfied with their facial appearance with the prosthesis. There was no sign of diplopia in one patient at all fields of gaze. Three patients had no diplopia at the central field of gaze. There were no complications of the implant extusion, migration or infection. Although this was only a small series of 7 cases, the titanium mesh or micromesh plates were proved to be a good alternative for such complicated orbital fractures.