Materials to facilitate orbital reconstruction and soft tissue filling in posttraumatic orbital deformaties lingxiao ye, xiaoming sun, yuguang zhang, ying zhang department of plastic and reconstructive surgery, ninth peoples hospital affiliated to the medical school of shanghai jiao tong university, shanghai 200011, china. Seventy patients with isolated blowout fractures of the orbital floor resulting in defect sizes of up to 2. Reconstruction of orbital floor for treatment of a pure blowout fracture. Early decompression is favorable for neural restitution. Orbital floor reconstruction in silent sinus syndrome. The goal of surgical repair in orbital floor fractures is twofold. Anatomical reconstruction of medial wall and orbital floor fractures. Internal orbital fractures in the pediatric age group. Hardly any other field in craniomaxillofacial surgery has changed so much in terms of diagnostics, biomaterial selection for reconstruction, surgical techniques including approaches and quality control.
The other option is to use the preformed orbital plate. The purpose of internal orbit floor reconstruction is the anatomical true to. 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. When it comes to surgical repair of orbital floor fractures, the consensus among oculoplastic specialists is that less is often more. Longterm followup of blowout fractures of the orbital. Orbital floor fractures are the most common traumatic fractures in the facial skeleton. A clinically significant orbital floor defect will be defined as a gap remaining after reduction or elevation of orbital floor fracture fragments that requires a semirigid implant to avoid postoperative enophthalmos or orbital dystopia.
Under these circumstances, the surgeon may reconstruct the defect using two separate plates, one for the medial wall and one for the orbital floor. Our case series demonstrates that dynamic changes in orbital floor position can occur after sinus reventilation. Pdf materials used for reconstruction after orbital. This script was created with an older version of mimics i think 18. A novel use of biomaterial implants for reconstruction of. The occurrence of mydriasis during orbital floor fracture reconstruction may cause significant. This script automatically fills in holes in the orbital floor as well as in the maxillar sinuses. A study of orbital reconstruction with lyophilized dura on 55 patients demonstrated a oneyear enophthalmos rate of 5. Many specialists encounter and treat orbital fractures. Designed from ctscan data, the threedimensional implants closely approximate the topographical anatomy of the human orbital floor and medial wall, to provide accurate reconstruction even after significant twowall fractures.
Objectives 1 to describe repair of complex orbital fractures using computer planning with preoperative. Relatively new in orbital floor repair is the use of nylon foil, a nonporous poly amide. Park, md, is a dual boardcertified facial plastic surgeon and ear, nose, and throat otolaryngology specialist who offers orbital floor reconstruction for residents of long island, queens and surrounding communities in new york. We evaluated 101 patients with pure blowout fracture or concomitant with zygomatic maxillary fracture. Posttraumatic orbital reconstruction is one of the most fascinating fields in reconstructive craniomaxillofacial surgery. Rapid prototype 3dimensional biomodel of an orbit exhibiting orbital floor and medial wall defects. Management of orbital complications in palatomaxillary. Automated orbital floor and maxillar sinus reconstruction. Outcomes of orbital floor reconstruction after extensive maxillectomy using the computerassisted fabricated individual titanium mesh technique q6 wenbo zhang, md,chi mao, md,yxiaojing liu, md,zchuanbin guo, md, phd,x guangyan yu, md, dds,kand xin peng, md, ddspurpose. Silent sinus syndrome describes an indolent and chronic disease characterized by atelectasis of the maxillary sinus due to obstruction of the ostium. Orbital reconstruction for orbit, orbital floor fracture. Case report comparative study of enophthalmos treatment with titanium mesh combined with absorbable implant vs. Resorbable alloplastic materials are used in many surgical applications.
Clinical management and reconstruction of isolated orbital floor fractures the 2mmthick coronal ct images of the study population were assessed based on these criteria, and a. Orbital floor reconstruction with pre contoured titanium. Selection of materials for orbital floor reconstruction. Nylon foil has provided favourable results in preliminary.
Bone grafts for the orbital floor have long been considered the standard treatment for orbital fracture repair. Whether the orbit reconstruction is indicated, natural and synthetic materials are available. Orbital floor reconstruction long island, ny queens, ny. Blunt trauma to the orbital rim is a frequent cause of orbital floor and medial orbital wall fractures. This retrospective study evaluated the clinical outcome after reconstruction of traumatic orbital floor defects using a polyglactin 910pds implant ethisorb. Incision choice, orbital volume restoration, appropriate orbital floor reconstruction, and permanent or temporary lower eyelid suspension during the primary surgery can all significantly impact the development of long. Orbit reconstruction an overview sciencedirect topics. Orbital floor symmetry after maxillectomy and orbital. Clinical management and reconstruction of isolated orbital. Automatic reconstruction of the orbital floor and the. Con anomalies branchial cleft cpt code surgery con anomalies branchial cleft pdf preseptal subtarsal approach for. In this video kevin dotremont explains how to do an automatic reconstruction of the orbital floor and the maxillary sinus for craniomaxillofacial applications using. Anatomical reconstruction of medial wall and orbital floor.
The resection of the orbital floor in maxillectomy surgery mandates either orbital exenteration or reconstruction to maintain orbital function. Current strategies in posttraumatic orbital reconstruction. Add to mymedicalexpo favorites requestbuttons catalog excerpts. Comprehensive solutions for orbital floor repair and reconstruction 2 pages. The principle of this approach requires an appropriate. For traumatic defects of the orbital floor, reconstruction using a polyglactin 910pds. A technical video illustrating the key steps in orbital repair. Pdf orbital floor fracture reconstruction using conchal.
Therefore, a conventional technique that preoperatively creates orbital reconstruction materials on the basis. Reconstruction of the orbital floor has to respect the course of the infraorbital nerve in the orbital floor. Trumatch cmf titanium 3dprinted orbital plates matrixmidface preformed orbital plates synpor porous polyethylene orbital implants depuy synthes part of the family of companies. This complicated anatomy makes repair and reconstruction of orbital. Materials used for reconstruction after orbital floor fracture. Some implants are available with a barrier surface to prevent tissue ingrowth when necessary. Although orbital reconstruction using implant materials is effective, it is difficult to assess the accuracy during surgery. A novel use of biomaterial implants for reconstruction of orbital floor fracture. Reconstruction of orbital floor fractures with maxillary. Additionally, complete reconstruction of the orbital floor is difficult in patients with massive comminution. Many fractures of the orbit, a common occurrence with facial trauma, never require surgery, which is customarily performed in patients with. The surgical treatment involved orbital floor reconstruction with a titanium mesh and under general anesthesia.
Many materials, from different sources, have been described for that task. Depending on the amount and severity of dislocation around the course of the infraorbital nerve, decompression might be indicated. Mydriasis during orbital floor fracture reconstruction. Postoperative computed tomography scans recorded after threedimensional 3d reconstruction were used to evaluate the symmetry of the orbital floor, including orbital floor height, orbital floor eminence, globe projection, orbital volume, and surface. Biomaterials for reconstruction of the internal orbit dr. The ultimate goals are the reconstruction of the bony orbital defect with restoration of anatomy, volume, function, and esthetics. Bone grafts were chosen for large defects, comminuted fractures or if other reconstruction eg, sinus was required. The orbital floor, which forms the roof of the maxillary sinus, slopes.
Outcomes of orbital floor reconstruction after extensive. Trigeminocardiac reflex during orbital floor reconstruction. Long term complications of orbital floor fracture repair. Orbital reconstruction is very difficult when the transition areas between the orbital floor and the medial wall is missing.
Materials to facilitate orbital reconstruction and soft. Original article reconstruction of orbital blowout fractures using medpor titanium mesh implants xiaohui han, shunhai yang, zhizhang dong, wangqiang feng department of ophthalmology, the second affiliated hospital of wenzhou medical university, wenzhou 325000, china. Medpor titanmaxorbital floor and wall the wider titanium mesh and extensions on the medpor titan max orbital floor and wall ofw implant provides the surgeon with an alternative to other repair materials for large orbital floor fractures andor combined fractures of the orbital floor and medial wall. If desired, medpor material may be cut and shaped to fit the patient needs and your preferences. We conducted a prospective, controlled, blinded pilot study to demonstrate that repair of induced rabbit orbital floor fractures with surgisis es cook biotech inc, west lafayette, ind provides adequate orbital content support while promoting. Pdf the medial wall and floor of the bony orbit are frequently fractured. Nineteen patients who underwent orbital floor reconstruction with individual titanium mesh were included in this study.
Pdf orbital floor reconstruction using porcine small. Con anomalies branchial cleft cpt code surgery orbital floor fractures intraoperative imaging changes. Introduction the unique and complex anatomy of the orbit, unless prebent plates are used, requires significant contouring of the implants to restore the proper anatomy. Intraoperative navigationassisted surgical orbital floor. These findings support the approach of delaying orbital floor reconstruction in cases of silent sinus syndrome treated with sinus reventilation, as such reconstruction may prove unnecessary over time.
Computerguided orbital reconstruction to improve outcomes. Costochondral graft is a suitable choice when orbital reconstruction is indicated. Costochondral graft for large orbital defects in floor. Our aim was to compare the outcomes and complications of resorbable implants and permanent implants in orbital floor fracture repair.
Injuries to the eye socket may result in an orbital fracture that requires reconstruction. Objective to evaluate the use of autogenous maxillary bone for the repair of orbital floor defects secondary to blunt facial trauma design retrospective case series of 41 patients with a mean followup of 1. Anatomic orbital floor plate, large recommended for orbital floor defects with medial and lateral wall involvement and reconstruction of tumor resections medial wing clears lacrimal duct mshaped cutout designates medial wing anatomic orbital floor plate, small anatomic orbital floor plate, medium anatomic orbital floor plate, large. A retrospective comparative case series of all orbital floor fracture repair cases 158 eyes from 1983 to 1998 was done. Pdf we report our experience with the repair of the orbital floor fractures and present new technical findings. Autogenous grafts for orbital floor reconstruction. The choice of the ideal material for reconstruction of orbital floor and walls remains highly controversial. Cosmetic and reconstructive procedures page 4 of 7 unitedhealthcare oxford clinical policy effective 01012018 19962018, oxford health plans, llc cpt code description 21179 reconstruction, entire or majority of forehead andor supraorbital rims. A study was undertaken to evaluate the safety of magnetic resonance imaging mri of metallic implants used in cranio orbital reconstruction stainless steel wire and titanium and vitallium plates and also to compare the degree of artifact created on computed tomographic ct. Synthetic prostheses were tailored to the orbital floor in clinically significant fractures.
Medpor is designed to accept screws and plates without cracking, providing you with more flexibility in fixation options and placement. The resultant collapse of the maxillary sinus is associated with inferior bowing of the orbital floor that increases the effective orbital volume. Original article reconstruction of orbital blowout. Orbital exenteration may be reserved for those tumors that encroach on the intraorbital contents in which more conservative surgery would violate oncologic margins or yield a. Comprehensive solutions for orbital floor repair and. Pdf orbital floor reconstruction using porcine small intestinal submucosa howard krein academia. Orbital reconstruction for orbit, combined fracture.
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