Medpor Titan Research Articles

Orbital floor defect caused by invasive aspergillosis: a case report and literature review.

Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters' view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino- orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene-Titanium Implants.

Complex bony orbital defects are reconstructively challenging due to loss of intraoperative anatomical landmarks and adjacent support. Presized and precontoured porous polyethylene-titanium implants (Medpor Titan 3D Orbital Floor Implant) are designed to reestablish normal orbital floor and medial wall anatomy and are modeled after anatomically averaged orbits. This is the first study to report clinical outcomes with this implant. This retrospective case series reviewed clinical data and outcomes for patients undergoing orbital reconstruction with a presized and precontoured porous polyethylene-titanium orbital implant from January 2016 to June 2018. A total of 34 orbits of 33 patients were identified (mean age: 43 ± 16 years, 70% men). Most bony defects were a result of trauma and included large orbital floor deformities (100%), medial wall defects (74%), disrupted inferomedial struts (68%), and broken posterior ledges (82%). Symptomatic diplopia (73%) and enophthalmos (89%, mean: 3.7 ± 2.1 mm) were common preoperatively. Many cases were revisions (44%). Mean follow up was 7.8 ± 6.7 months. All patients had improved globe positioning, enophthalmos, and hypoglobus. Seven patients had persistent postoperative diplopia: 6 responded to prism therapy and 1 required strabismus surgery. One patient required retrobulbar hematoma drainage and 1 patient required implant explantation due to chronic infection. Commercially available presized and precon toured porous polyethylene-titanium implants are useful for complex orbital bony defects and can achieve functional improve ments in diplopia, enophthalmos, and extraocular motility with a low incidence of postoperative complications or revisional surgery.

Retrosigmoid Suprameatal Approach for Resection of Petrotentorial Cerebellopontine Angle Meningioma: Operative Video and Technical Nuances.

Meningiomas are the second most common tumor to arise in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a petrotentorial meningioma in the cerebellopontine angle via a retrosigmoid suprameatal approach. Drilling of the hyperostotic suprameatal tubercle was necessary to gain access to the dural origin and anterior petrosal extent of the tumor. The nuances of microsurgical and skull base technique are illustrated including microsurgical dissection of the tumor away from the brainstem and neurovascular structures, facial nerve preservation, and fat graft-assisted Medpor Titan reconstruction to prevent cerebrospinal fluid leakage. A gross total resection was achieved, and the patient was neurologically intact. In summary, the retrosigmoid suprameatal approach is an important strategy in the armamentarium for surgical management of petrotentorial meningiomas in the cerebellopontine angle. The link to the video can be found at: https://youtu.be/kwQP6BSYK7U .

Orbital fracture repair outcomes with preformed titanium mesh implants and comparison to porous polyethylene coated titanium sheets

BackgroundRestoration of orbital volume after internal orbital fractures can prevent enophthalmos. A variety of allografts are commonly used including titanium mesh with and without porous polyethylene coating. Some controversy exists over the use of uncoated titanium mesh in the orbit. Newer products contoured to the three dimensional orbital anatomy aim to improve reestablishment of the complex orbital shape though studies of outcomes with their use are limited. MethodsA retrospective chart review was performed to evaluate surgical outcomes in all patients who underwent orbital fracture repair with DePuy/Synthes titanium MatrixMIDFACE prefabricated implants (PFTi) as compared with porous polyethylene/titanium hybrid implants (PPETi) including Stryker Medpor Titan, MTB, and BTB implants. Incidence of reoperation, diplopia, and movement restriction between PFTi and PPETi groups and the risk ratio of the above outcomes between implant types were compared. ResultsA total of 464 orbital implants were reviewed. Patients were divided by implant type with 195 patients receiving a PFTi implant and 269 patients receiving PPETi implant. (PFTi) and 269 had placement of a porous polyethylene/titanium hybrid implant. Despite statistically significant increased probability of utilization in more complex and delayed fractures, the PFTi implant showed no significant difference in complication profile or reoperation rate compared to the more commonly used PPETi. ConclusionsPFTi implants, designed to replicate the native orbital shape, have similar surgical outcomes and no difference in complication profile compared to standard porous polyethylene/titanium implants hybrid plates.

Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases.

Postoperative cerebrospinal fluid (CSF) leaks and headaches remain potential complications after retrosigmoid approaches for lesions in the posterior fossa and cerebellopontine angle. The authors describe a simple repair technique with an autologous fat graft-assisted Medpor Titan cranioplasty and investigate the incidence of postoperative CSF leaks and headaches using this technique. A retrospective chart review was conducted on all cases (n = 60) of retrosigmoid craniectomy from September 2009 to May 2014 in patients who underwent fat graft-assisted cranioplasty. After obtaining a watertight dural closure and sealing off any visible mastoid air cells with bone wax, an autologous fat graft was placed over the dural suture line and up against the waxed-off air cells. The fat graft filled the retrosigmoid cranial defect and was then bolstered with a Medpor Titan (titanium mesh embedded in porous polyethylene) cranioplasty. A postoperative mastoid pressure dressing was applied for 48 h, and prophylactic lumbar drainage was not used. Factors examined in this study included postoperative CSF leak (incisional, rhinorrhea, otorrhea), pseudomeningocele formation, incidence and severity of postoperative headache, length of hospital stay, and length of follow-up. No patients developed postoperative CSF leaks (0 %), pseudomeningoceles (0 %), or new-onset postoperative headaches (0 %) with the described repair technique. There were no cases of graft site morbidity such as hematoma or wound infection. Mean duration of postoperative hospital stay was 3.8 days (range 2-10 days). Mean postoperative follow-up was 12.4 months (range 2.0-41.1 months). Our multilayer repair technique with a fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leaks and new-onset postoperative headaches after retrosigmoid approaches. Postoperative lumbar drainage may not be necessary.

Application of Medpor and Medpor Titan surgical implant for treatment of traumatic complex orbital fracture

Objective To investigate the clinical application of Medpor and Medpor Titan surgical implant for traumatic complex orbital fracture reconstruction.Methods Retrospective charts were reviewed of 10 eyes of 10 patients with complex orbital fractures who underwent the reconstructive surgery by using Medpor or Medpor Titan surgical implant.Evaluation of enophthalmos,the position and the movement of the affected eyeball was recorded for analysis.Results All patients were followed up for 12 months.There was no extrusion,rejection,infection or other complications of Medpor and Medpor Titan surgical implant during follow-up.The average enophthalmos was (3.00 ± 0.75) mm and the position of the affected eyeball was (2.10 ±0.88)mm bellow the contralateral side preoperatively.6 patients suffered from eyeball movement restriction.During the postoperative follow-up,enophthalmos was completely corrected in 7 patients,while the other 3 patients had residual 1 mm enophthalmos.The affected eyeballs were repositioned in 8 cases and 2 cases had residual 1 mm lower position.Eye movement was satisfactory in all directions in 5 cases,1 case with the limitation of abduction.Diplopia disappeared in 8 cases,1 case with vertical diplopia and 1 case had horizontal diplopia.Conclusion Medpor or Medpor Titan surgical implant can be used to reconstuct traumatic complex orbital fractures in order to improve the orbital volume and to correct enoththalmos effectively. Key words: Fracture, orbital; Medpor; Medpor Titan; Surgical implant

Skull Base Reconstruction after Far Lateral Transcondylar Approaches Using Autologous Fat Graft-Assisted Medpor Titan Cranioplasty: Surgical Technique and Nuances

Object: One of the most common complications arising after far lateral transcondylar surgery for lesions in the ventral foramen magnum and the craniovertebral junction is cerebrospinal fluid (CSF) leakage. A simple reconstruction technique to prevent postoperative CSF leakage is described using an autologous fat graft-assisted Medpor Titan cranioplasty.

Reconstruction of pterional defects after frontotemporal and orbitozygomatic craniotomy using Medpor Titan implant: Cosmetic results in 98 patients

ObjectiveReconstruction of pterional and temporal defects after frontotemporal (FT) and orbitozygomatic (OZ) craniotomy is important for avoidance of temporal hollowing, maintaining functional restoration, and achieving optimal cosmesis. The objective of this study is to describe our experience and cosmetic results with pterional reconstruction after FT and OZ craniotomy with the Medpor Titan implant. MethodsNinety-eight consecutive patients underwent reconstruction of pterional and temporal defects after FT and OZ craniotomy using the Medpor Titan implant. The implant was shaped to recreate the pterion to provide coverage for the cranial defect and to bolster the temporalis muscle to prevent temporal hollowing. The implant was then secured to the bone flap with titanium screws. Cosmetic evaluation was performed from both surgeon's and patient's perspective. ResultsOf 90 patients who underwent cosmetic assessment at the 3 month follow-up, temporalis asymmetry was noticed subjectively by three patients and noted in 7 patients by the surgeon. Orbital asymmetry was not noticed in any cases by either surgeon or patient. Overall patient satisfaction was found in 89 of 90 patients (98.9%). There were no cases of temporal hollowing. One patient had a delayed wound infection, and one had an inflammatory reaction that required removal of the implant. ConclusionsOur technique using the Medpor Titan implant is a fast and effective method for pterional reconstruction after FT and OZ craniotomy with excellent cosmetic results and patient satisfaction. The implant combines the advantages of both porous polyethylene and titanium mesh, including easy custom-shaping without sharp edges, structural support and relatively lower cost.

Reconstruction of cranial base defects using the medpor titan implant: Cranioplasty applications in acoustic neuroma surgery

Reconstruction of cranial base defects using the medpor titan implant: Cranioplasty applications in acoustic neuroma surgery

Hematic Cyst in a Barrier-Covered Porous Polyethylene/Titanium Mesh Orbital Floor Implant

Hematic cyst formation after placement of nonporous alloplastic orbital floor implants is well described. A benefit of porous polyethylene is fibrovascular ingrowth without capsular formation. This ingrowth inhibits hematic cyst formation. In the case presented here, a hematic cyst developed on a screw-fixated porous polyethylene/titanium mesh implant (Medpor Titan B-T-M, Porex Surgical, Newnan, GA, U.S.A.). The risk factor for this patient was the nonporous barrier surface of the implant and inadequate fracture reduction. Proper surgical technique, including implant sizing, placement, and fixation, are factors reported to prevent hematic cyst formation. This patient's symptoms resolved after removal of the implant and cyst and replacement of the orbital implant.

Orbital Floor Reconstruction

This is a retrospective study with the aim to evaluate orbital floor reconstruction with autogenous bone and alloplastic materials consisting of Medpor, Medpor Titan, Titanium, and resorbable plates. We evaluated 101 patients with pure blow-out fracture or concomitant with zygomatic maxillary fracture. We reviewed patients' documentation before and after surgery and 12 months after reconstruction. Thirteen patients with Medpor, 42 patients with Medpor Titan, 30 patients with Titanium, 5 patients with calvarial bone graft, 8 patients with iliac bone graft, and 3 patients with bioresorbable plates were treated. Medpore and Medpor-Titan-Medpor 1.5 to 2 mm in thickness were used. Autogenous bone graft 3 to 5 mm in thickness was used. Results showed that autogenous and alloplastic materials could be used in orbital floor reconstruction; autogenous bone graft had minimal postoperative infection, and it is a good choice in major orbital defects. Titanium mesh and MTM with excellent structural support are used in large orbital floor defects. Resorbable plates are good alternative materials in pediatric patients.

A Case of Orbital Mucocele Lined With Two Types of Epithelial Cells After Orbital Wall Fracture Repair

Purpose: The authors report a case of orbital mucocele lined with two types of histological epithelial cells developed after repair of the orbital wall fractures. Case summary: A 53-year-old man presented with proptosis of the left eye for two years. The patient had a history of left orbital inferomedial wall fracture repair ten years earlier at a different hospital. Examination revealed 4 mm proptosis and superior globe displacement of the left eye. Restriction of left ocular movements on elevation, depression and adduction were observed. A computed tomography scan demonstrated a large, non-enhancing, cystic tumor in the left inferior orbit with the inferior and medial wall displaced toward the paranasal sinus. An orbital cystic tumor was excised with the removal of previously-inserted orbital implant via a transconjunctival and transcaruncular approach. The inferior, and medial orbital walls were reconstructed using a MEDPOR TITAN implant. The initial pathologic diagnosis was epidermal cyst. Histopathologic re-review revealed an orbital cyst lined with both stratified squamous epithelium and pseudostratified ciliated columnar epithelium, thus diagnosis was changed to orbital mucocele. Proptosis and restriction in ocular motility improved postoperatively. Conclusions: Mucocele formation should be considered in patients in whom a cyst developed after orbital fracture repair.

Orbital Floor Fracture Repair

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.