Reconstruction Of Orbital Floor Fractures Research Articles

Clinical and radiographic assessment of patient-specific transantral reconstruction of orbital floor fractures: A case series

To clinically and radiographically evaluate patient-specific titanium meshes via a trans-antral approach for correction of enophthalmos and orbital volume in patients with recent unilateral orbital floor fracture.Seven patients with unilateral orbital floor fractures received patient-specific titanium meshes that were designed based on a mirror-image of the contralateral intact orbit. The patient-specific implants (PSIs) were inserted via a trans-antral approach without endoscopic assistance. The patients were evaluated clinically for signs of diplopia and restricted gaze as well as radiographically for enophthalmos and orbital volume correction. Diplopia was totally resolved in two of the three patients who reported diplopia in the upward gaze. Whereas enophthalmos significantly improved in all but two patients, with a mean value of 0.2229 mm postoperatively compared to 0.9914 mm preoperatively. CT scans showed excellent adaptation of the PSIs to the orbital floor with a mean reduction of the orbital volume from 29.59 cc to 27.21 cc, a mean of 0.6% smaller than the intact orbit.It can be concluded that the proposed PSI can offer good reconstruction of the orbital floor through an isolated intraoral transantral approach with minimal complications. It could of special benefit in extensive orbital floor fractures.

Changes in Volume and Bone Density of Calvarial Grafts After Two Years of Orbital Reconstruction.

One of the greatest challenges in orbital reconstruction is to obtain adequate orbital volume and globe projection after traumatic injury. Autologous bone graft has been considered the gold standard for orbital floor reconstruction, but the harvesting yields many possible complications, such as donor site morbidity. Bone resorption is a frequent problem that can lead to insufficient volume after graft placement. There is a theoretically lower resorption rate of skull bone grafts, even though the exact amount is not known yet. This study is the first to evaluate bone volume and density changes of calvarial split bone grafts after orbital floor reconstruction with a 2-year follow-up. Bone volume and density of calvarial split grafts were determined using computed tomography scans and the software program RadiAnt Dicom Viewer in a total of 10 patients with orbital floor fracture reconstruction. Computed tomography scans taken immediately after surgery (T0) and after a postoperative period of 2 years (T1) were evaluated. The authors found a mean bone volume reduction of 34.25% after 2 years. Bone density was still high after 2 years (over 850 HU), with a mean reduction of 8%. Based on these findings, calvarial split bone grafts represent the ideal reconstruction material for orbital floor fractures.

Assessment of the efficacy of auricular conchal cartilage graft in repairing orbital floor fractures and its effect on diplopia: a nonrandomized clinical trial.

A prospective single-arm, nonrandomised clinical trial was conducted during the past 4 years (from 2018 to 2022). A total of 15 cases, who had visited the department of oral and maxillofacial surgery department with orbital floor fractures, were enrolled. The participants underwent conchal cartilage grafting for orbital floor fracture reconstruction. The time factor to perform the surgery after trauma had been considered. Patients were closely monitored for the development of double vision (diplopia) at 15 days, 1 month, and 3 months postsurgery. The results showed statistically significant differences during the follow-up period following the surgical procedure. They appeared to have complete restoration of eye movements, restoration of the normal positioning of the eyeball affected by the orbital floor fracture compared to the healthy eyeball, and regression of double vision (diplopia) throughout the follow-up period. Using the auricular conchal cartilage graft in repairing fractures of the orbital floor resulted in the improvement of the functional aspect of the eyeball and the restoration of the esthetic aspect.

Ultra-High Molecular Weight Polyethylene (marPOR) is a Suitable Material for the Reconstruction of Orbital Floor Fracture Defects in Human Cadavers

Abstract Purpose Despite there being different materials for orbital floor reconstruction available today, outcomes are still not satisfying. In recent years, ultra-high molecular weight polyethylene (UHMWPE) has gained popularity in the field of orthopedic surgery due to its good biocompatibility and low infection rate. With its three-dimensional compound structure, it combines high stability and ductility, making it a potential material to be used for orbital floor reconstruction. Methods In a cadaver study, an overall of eighteen orbits were included. Fractures of the inferior wall were induced and then reconstructed using Polyglactin 910/PDS composite (Ethisorb) and UHMWPE (marPOR). Orbits were scanned by cone-beam CT in each condition: Intact, fractured and reconstructed with Ethisorb, marPOR 0.85 mm and marPOR 1.5 mm. Segmented orbital volumes were calculated by specialized software (Disior bonelogic CMF). Results All materials led to sufficient reconstruction of the initial orbital volumes (Ethisorb: p < 0.001; marPOR 0.85 mm: p = 0.003; marPOR 1.5 mm: p < 0.001). Orbits that were reconstructed with marPOR 0.85 mm showed the least mean volume difference from intact orbital volumes. Conclusion UHMWPE (marPOR) offers reliable reconstruction of orbital floor fractures combined with good stability, ductility and biocompatibility.

Modified procedure for reconstructing the inferior wall of the orbit: identification of a reliable new landmark

BackgroundIn orbital floor reconstruction, fractures involving the slope of the posterior end of the orbital floor make it difficult to determine the best location for implant placement. Therefore, landmarks for reconstruction are desirable to perform safe and reproducible reconstruction surgery.MethodsWe developed a surgical procedure that focuses on three orbital landmarks: the infraorbital nerve, the inferior margin of the greater wing of the sphenoid bone, and the posterior superior wall of the maxilla.ConclusionsLandmark-based orbital floor fracture reconstruction enables accurate reconstruction of fractures that extend to the slope of the posterior end of the orbital floor.

A Retrospective Study that Evaluates Reconstruction of Orbital Floor Fractures with Titanium Mesh and Cartilaginous Graft

A Retrospective Study that Evaluates Reconstruction of Orbital Floor Fractures with Titanium Mesh and Cartilaginous Graft

Quantitative assessment of increase in orbital volume after orbital floor fracture reconstruction using a bioabsorbable implant.

To assess the postoperative changes in the orbital volume and the degree of enophthalmos after orbital floor fracture reconstruction using a bioabsorbable implant and to determine the predictors of postoperative orbital volume change. Single-center, retrospective case series of 16 patients who underwent orbital floor fracture reconstruction using a bioabsorbable implant [poly(L-lactic acid)-poly(glycolic acid)/β-tricalcium phosphate; Biobsorb β®] were included. Three-dimensional volumetric calculations of orbit were determined using computed tomography scans and the degree of enophthalmos was assessed via Hertel exophthalmometry. Postoperative changes in the orbital volume and the degree of enophthalmos and their correlation were assessed. The mean volume of fractured orbits immediately after surgery was 22.26 ± 1.98 cm3, increasing to 23.67 ± 2.00 cm3 at 6-month follow-up (p < 0.001); the increased orbital volume was associated with postoperative deformation of the implant. The mean degree of enophthalmos was 0.09 ± 0.27 mm at 1-month follow-up, which increased to 0.66 ± 0.30 mm at 6-month follow-up (p = 0.001). Increase in orbital volume and enophthalmos progression showed a linear correlation (R = 0.682, p = 0.004). Patients with more herniated orbital tissue preoperatively showed increased postoperative orbital volume change (p = 0.015), whereas the size of the fracture area was not predictive of postoperative orbital volume change (p = 0.442). Increase in orbital volume by deformation of the bioabsorbable implant resulted in progressive enophthalmos during the postoperative follow-up period after orbital floor fracture reconstruction. Thus, careful selection of proper implants before surgery and close postoperative follow-up is needed for an optimal outcome.

Combined Subciliary/Transantral Approach for Reconstruction of Orbital Floor Fracture

Orbital floor fracture, especially with constriction of orbital soft tissue, should be reconstructed surgically. Although various approaches to treat the orbital floor have been reported, procedures have not been unified among hospitals or surgeons. Since 2009, we have adopted a procedure combining a transorbital approach via subciliary incision with a transantral approach through upper gingival incision. The combined approach compensates for the shortcomings of each approach, leading to successful reconstruction. It is applicable safely for trapdoor fracture of the orbital floor in children, which more frequently constricts orbital soft tissue and which leaves permanent diplopia. This report retrospectively assessed clinical preoperative findings and postoperative outcomes of patients who received reconstruction of orbital floor fracture with the combined approach in our department from August 2009 through March 2021. Data of 21 patients with orbital floor fracture were analyzed, only one (4.8%) of whom had postoperative diplopia. Specifically, we describe children with trapdoor fracture treated with the combined approach, resulting in complete recovery. The combined approach stands as an excellent procedure for reconstruction of orbital floor fracture in adults and even in children.

Refining Indications for Orbital Floor Fracture Reconstruction: A Risk-Stratification Tool Predicting Symptom Development and Need for Surgery.

Challenges in orbital floor fracture management include delayed symptom onset and controversial surgical indications based on radiographic findings. This study assessed which imaging characteristics most reliably predict symptomatology to generate a tool quantifying individual need for surgery on initial presentation. The clinical course for all patients with isolated orbital fractures at a single institution from 2015 to 2017 were reviewed. Trauma mechanism, computed tomographic scan findings, and symptoms necessitating surgery (diplopia, enophthalmos) were noted. Univariable and multivariable regression modeling was used to generate a predictive risk model for operative fractures. One hundred twenty-one patients with isolated orbital fractures were identified. Mechanism of injury included falls (41 percent), assault (37 percent), and vehicular trauma (17 percent). Patient follow-up averaged 4.4 ± 4.8 months. Average orbital floor fracture area was 2.4 cm2 (range, 0.36 to 6.18 cm2), and orbital volume herniation averaged 0.70 cm3 (range, 0.01 to 4.23 cm3). Twenty-one patients (17.3 percent) required surgical intervention for symptomatic fractures. The strongest predictors of symptoms were orbital volume increase greater than 1.3 cm3 (OR, 10.5; p = 0.001) and inferior rectus displacement within/below the fracture line (OR, 3.7; p = 0.049). Mechanical fall was risk-reducing (OR, 0.08; p = 0.005). Symptom risk was stratified from low (3.6 percent) to high risk (71 percent) (C-statistic = 0.90). The volume of herniated orbital contents was significantly more predictive of symptoms than fracture area (C-statistic = 0.81 versus C-statistic = 0.66; p = 0.02). The proposed risk tool allows highly accurate, early prediction of symptomatic orbital floor fractures. Findings suggest that orbital volume change, not fracture area, more reliably informs operative indications, along with inferior rectus muscle caudal malposition. A simplified stepwise decision algorithm demonstrates the potential utility of this risk-assessment tool. Risk, III.

Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta-analysis.

The aim of this network meta-analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials. PubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications. Nine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l-lactic acid and dl-lactic acid (P[L/DL]LA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts. P(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.

Assessment of a Consecutive Series of Orbital Floor Fracture Repairs With the Hess Area Ratio and the Use of Unsintered Hydroxyapatite Particles/Poly l-Lactide Composite Sheets for Orbital Fracture Reconstruction

The purpose of this study is to report the outcomes of a series of orbital fracture repairs, their assessment with the Hess area ratio (HAR%), and the use of unsintered hydroxyapatite (HA) implants for reconstruction. This study involved 207 consecutive unilateral orbital fractures with symptomatic diplopia that underwent surgical repair within 28 days of injury. Ocular movement was measured presurgery and at 3 and 6 months postsurgery by Hess chart with calculation of the HAR%. Surgery was conducted on 207 patients (161 males and 46 females; mean age, 27.8years) at a mean of 9.9days postinjury and with a mean follow-up of 8.6months. There were 160 patients with orbital floor fractures, 27 with medial wall fractures, and 20 with combined orbital medial wall and floor fractures, 135 of 207 patients had orbital blowout fractures, and 72 had orbital trap-door fractures. The HAR% improved significantly from a mean of 73.8% preoperatively to 92.7% postoperatively (P<.01). Orbital fractures were reconstructed with either unsintered HA particles/poly l-lactide composite sheet (133 patients), a silicone silastic sheet (47 patients), a combination of sheets (15 patients), or without an implant (12 patients). There was no significant difference in the HAR% improvement between the different implants. Very good outcomes can be achieved with early orbital floor fracture repair surgery, which can be assessed preoperatively and postoperatively by HAR%. Unsintered HA/poly l-lactide composite sheets are an effective absorbable material for orbital floor fracture reconstruction.

Reconstruction of orbital floor fractures using a porous polyethylene implant: outcomes in the early, intermediate and late postoperative periods

Objective: The porous polyethylene implant (PPEI) is one of the most commonly used alloplastic materials in cranio-maxillofacial surgery. It is widely preferred because of its biocompatible, durable, flexible and thin nature as well as for its low complication rates. The purpose of the present study was to review the clinical and surgical outcomes of PPEI usage for orbital floor fractures. Methods: The present study included 76 patients who underwent orbital floor fracture reconstruction using PPEI between July 2000 and July 2018. All demographic characteristics of the patients were recorded and the patients were questioned and/or examined whether there was any complaint or complication secondary to the surgery. Results: The mean age of the patients was 35.2 years with a male predominance. The most common causes of injury were in-vehicle traffic accidents, falls, physical assaults and pedestrian accidents, respectively. 73 patients had other concomitant fractures of the facial bones along with the orbital floor fracture. The mean time between the injury and the surgical repair was eight days. Scleral show was observed in two patients (2.6%) due to scar contracture of the subciliary incision whereas one patient had surgical removal of the PPEI. Conclusion: The present study revealed that PPEI is a reliable and flexible material for the reconstruction of orbital floor fractures with a low risk of complications. To prevent or minimize postoperative complications, the orbital septum must be repaired meticulously.

Reconstruction of Orbital Floor Fractures with Titanium Micromesh: Our Experience.

The purpose of this study was to assess the use and accuracy of the titanium micromesh for primary internal orbital reconstruction in cases of either pure or impure orbital blowout fractures. Retrospective case series of 21 patients with a mean follow-up of 12months. Department of Dental Surgery of a teaching tertiary medical college Hospital. Twenty-one consecutive patients who underwent surgical reconstruction of orbital floor/or Combination of floor and rim fractures usingtitanium micromesh. Persistence of diplopia, orbital dystopia, implant extrusion, enophthalmos, infection, and complications. The recorded data included age, gender, cause of trauma, diplopia, enophthalmos, ocular motility, preoperative orbital PNS/CT, and postoperative paranasal sinus view skull preoperative and postoperative ophthalmological examination. Most of the patients were males and resulted from trauma inflicted during RTA, sport injuries or assault. The most Common fracture pattern was impure Blow out fractures, and commonly associated other facial fractures were midfacial fractures. Clinical examination along with diagnostic aids such as computed tomography of orbital fractures was used. Orbital floor exploration was performed in 21 cases due to functional or aesthetic deficits. All orbital floor bone defects required reconstruction. In these cases, orbital floor was reconstructed with .3mm titanium micromesh implant. We did not encounter any major complications related to the incisions or implant material, though sample size was small. The rate of complication in which correction was difficult (diplopia) was lower [4%, 1 case]. Titanium mesh gives excellent result in orbital floor fractures. Surgical anatomical landmarks knowledge is very important to prevent any intra- or postoperative complications.

Orbit in a Box: A Simplified Technique for Patient-Specific Virtually Planned Orbital Floor Reconstruction.

Possibilities for the reconstruction of orbital floor fractures have been extensive for years with regard to materials, methods and differential indications and are inconsistent worldwide. With the spread of CAD/CAM techniques, new and mostly time-consuming possibilities for orbital floor reconstructions have been added. The simple and time-efficient CT-to-patient-specific implant workflow presented here shows that a "form-box" can be created from a patient's computer tomography data set using planning software and a 3D printer. The box is then used to form a patient-specific implant for orbital floor reconstruction: here polydioxanone foil was used, for which stable thermoplastic deformability has been demonstrated for 3D reconstructions. Patient-specific thermoplastic shaping of polydioxanone is feasible in a theoretical clinical setting, though its thermoplastic shaping is not yet certified for clinical use. However, a flexible adaptation of the "form-box" design to other materials is possible by setting a single planning parameter. The simple structure of the box and its straightforward planning/fabrication process with widely available low-cost materials offer the possibility that a surgeon without a 3D specialist can produce a "form-box" for next day surgery if needed.

Alloplastic reconstruction of orbital floor fractures: a systematic review and pooled outcomes analysis

Orbital floor defects from traumatic injuries can be successfully repaired surgically utilizing alloplastic implants. The objective of this study was to conduct a comprehensive systematic review of alloplastic implant materials utilized in the repair of orbital floor fractures stratified by material type, indication for surgery, and outcomes in all reported cases to date. A comprehensive systematic review of published literature on alloplastic periorbital implant studies was conducted utilizing Medline/PubMed database without timeframe limitations. Articles were reviewed in full by multiple authors and outcomes data were collected. A total of 11 studies (n = 585 patients) were identified to meet the inclusion criteria. Overall, 25 total surgical complications (4.3%) were noted, including infection, inflammation, graft migration or explantation, and hematoma. Overall, porous polyethylene (PPE) implants were associated with the highest rate of infection (2.0%) compared with all other implant types analyzed. Poly-l-lactic acid (PLLA) implants were associated with the highest rate of graft explantation (5.9%). Explantation was required in a total 0.6% of all implants (n = 3). Alloplastic implants are a reliable means of reconstructing the orbital floor following trauma. It is imperative for surgeons to understand the relative risks for each type of implant to develop postoperative complications in order to optimize outcomes. Level of evidence: Level III, therapeutic study

The Characteristics of Lower Eyelid Reverse Ptosis After Reconstruction of Orbital Floor Wall Fracture Using Transconjunctival Approach.

The purpose of this study was to evaluate the changes of lower eyelid position and the incidence of reverse ptosis after reconstruction of orbital floor fracture. The authors retrospectively reviewed the clinical records of patients who received reconstruction of orbital floor wall fractures between 2014 and 2017. Digital photographs were taken preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Main measurements were marginal reflex distance 2 (MRD 2), which was measured by analyzing the digital photographs using ImageJ software. Among 264 patients with orbital wall fracture, The authors enrolled 32 eyes (18 right eyes and 14 left eyes) of 32 patients (21 males and 11 females) with a mean age of 32.1 years (range, 16-57 years). 7 (21.9%) of 32 patients had reverse ptosis at postoperative 3 months. When MRD2 of affected eye was compared based on the fellow eye, 7 patients with reversed ptosis showed a definite MRD 2 decrease (>1 mm) of affected eye from postoperative 1 month. Age showed a significant negative correlation with the difference of MRD2 between affected and fellow eye at postoperative 1 and 3 months (r = -0.378, P = 0.033 and r = -0.372, P = 0.036, respectively). Postoperative complications were not observed in all patients. The transconjunctival access in orbital floor wall surgery is a safe and useful surgical approach. However, some may have a reverse ptosis postoperatively, especially older patients. Reverse ptosis is a major clinical finding that should not be overlooked in post-operative follow-up.

Periorbital Reconstruction by "Periorbital Patch" Technique Using a Pericardium-Based Collagen Membrane and Titanium Mesh.

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.

Comparative Study between Conchal Cartilage Grafts and Split Rib Grafts in the Reconstruction of Orbital Floor Fractures

ABSTRACTBackground: Orbital floor fractures always represent achallenge for reconstruction. Various techniques for treatmenthad evolved over the past years, each with their strengths andweaknesses. The main aim of surgical repair is to relocateherniated orbital tissue and fat back into the orbit restoringboth the function and aesthetic aspect. Reconstruction oforbital floor can be performed using various types of materials,either autologous as rib grafts or cartilage grafts or alloplasticas titanium mesh.Aim of the Study: The aim of this study is to compare theresults of using autologous cartilage grafts with those of splitrib graft in small posttraumatic orbital floor defects reconstruction.Patients and Methods: 30 patients with orbital floordefects due to maxillofacial trauma. They were divided into2 groups according to the technique of reconstruction: Group1: 15 patients who had reconstruction by onlay split rib graftsGroup 2: 15 patients who had reconstruction by conchalcartilage grafts, using either unilateral or sutured bilateralconchal cartilage grafts in large defects. Both methods wereanalyzed clinically and radiologically and were compared asregards, their advantages and disadvantages Postoperativeassessment using CT scan were used.Results: With the conchal cartilage grafts, the results weremore favorable with statistically significant decrease incomplications.Conclusion: Reconstruction of orbital floor fracturesusing conchal cartilage grafts represents a safe and reliablemethod of reconstruction with less complications.

Orbital Reconstruction: Patient-Specific Orbital Floor Reconstruction Using a Mirroring Technique and a Customized Titanium Mesh.

Enophthalmos is a severe complication of primary reconstruction of orbital floor fractures. The goal of secondary reconstruction procedures is to restore symmetrical globe positions to recover function and aesthetics. The authors propose a new method of orbital floor reconstruction using a mirroring technique and a customized titanium mesh, printed using a direct metal laser-sintering method. This reconstructive protocol involves 4 steps: mirroring of the healthy orbit at the affected site, virtual design of a patient-specific orbital floor mesh, CAM procedures for direct laser-sintering of the customized titanium mesh, and surgical insertion of the device. Using a computed tomography data set, the normal, uninjured side of the craniofacial skeleton was reflected onto the contralateral injured side, and a reconstructive orbital floor mesh was designed virtually on the mirrored orbital bone surface. The solid-to-layer files of the mesh were then manufactured using direct metal laser sintering, which resolves the shaping and bending biases inherent in the indirect method. An intraoperative navigation system ensured accuracy of the entire procedure. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography data in 7 treated patients. The technique described here appears to be a viable method to correct complex orbital floor defects needing delayed reconstruction. This study represents the first step in the development of a wider experimental protocol for orbital floor reconstruction using computer-assisted design-computer-assisted manufacturing technology.

Reconstruction of Inferior Orbital Wall Fractures Using Bone Fragments.

Various materials have been used as implants in orbital floor fractures. The fractured bone fragments, however, are not usually used because of their small size and delicate characteristics. To overcome this limitation, the authors used autologous bone fragments combined with fibrin glue and an absorbable plate to repair inferior orbital wall fractures. Thirty-four patients with orbital floor fractures treated in a single center from January 2013 to September 2014 were prospectively evaluated. Patients' demographic characteristics, clinical signs and symptoms, physical examination findings, postoperative complications, and preoperative and postoperative computed tomography findings were assessed. Fracture repair by a transconjunctival approach in which bone fragments were merged with fibrin glue and an absorbable plate was performed in all the patients. Postoperative computed tomography showed good orbital fracture reduction and soft tissue restoration in all the patients. Five patients developed postoperative diplopia; however, this symptom resolved spontaneously. Exophthalmometry showed that the degree of enophthalmos had improved significantly. Based on the results of this study, the combination of autologous bone fragments and absorbable mesh appears to be a safe and feasible option for the reconstruction of orbital floor fractures.