Orbital corrections with the use of alloplastic material

After a severe trauma of the face, e.g. fractures involving the zygoma, the upper jaw or other orbital bone alteraions and deviations of the bony orbital contours and also of the orbital contents can subsist, even after primary operative correction. The patients have functional as well as cosmetic complaints. In consequence of eyeball dislocation and incarceration or fibrosis of the external eye muscles, the patients also complain of diplopia in one or more directions. Due to the bony orbit enlargement and reduction of the orbtial contents, the eye is moved inferiorly and backwards, also causing diplopia, ptosis and a deep sulcus of the upper lid. The treatment consists in closing and sufficient raising of the orbital floor correction of the enophthalmos. To cover the floor fracture, we apply 1-8 perforated Teflon implants which are placed under the periost of the orbital floor. To correct the enophthalmos, we use 30-50 Teflon beads with a diameter of 5 mm, and placed them in a sub-periorbital pocket laterally above and behind the eyeball, thus ensuring that the eye will be forced forwards in the cone-shaped orbit and so diminish or eliminate the enophthalmos. The operation is performed in close cooperation between an ophthalmologist and a plastic surgeon. Most of our cases also needed operative muscle correction. Although not all deviations could be totally corrected, we always achieved a clear improvement, and all 36 patients obtained a useful field of binocular single view. Until now we have had no implant infections or rejections. We should like to consider that this method of correction will have its own place in the treatment of orbital deformities.