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Orbital floor reconstruction with an alloplastic resorbable polydioxanone sheet.
A Baumann1, G Burggasser, N Gauss
1University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical School, University of Vienna, Austria. arnulf.baumann@akh-wein.ac.at
International Journal of Oral and Maxillofacial Surgery
|October 4, 2002
Summary
Polydioxanone implants can reconstruct orbital floor fractures, but may lead to enophthalmos in large defects due to weak scar tissue after resorption. Use PDS implants cautiously for moderate fractures without significant orbital fat herniation.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Biomaterials Science
Background:
- Orbital floor reconstruction is crucial after blow-out and midface fractures to prevent enophthalmos and tissue relapse.
- Resorbable implants offer an alternative to traditional materials for internal orbital wall reconstruction.
Purpose of the Study:
- To evaluate the skeletal and functional outcomes of reconstructing internal orbital wall fractures using polydioxanone (PDS) implants.
- To assess the efficacy of PDS implants in preventing enophthalmos based on fracture size.
Main Methods:
- Retrospective evaluation of 31 patients who underwent orbital floor reconstruction with 0.25 mm or 0.5 mm-thick PDS implants.
- Fracture size was categorized as small, moderate, or large via CT scans and operative records.
- Outcomes assessed included enophthalmos, diplopia, and scar integrity post-implant resorption.
Main Results:
- Enophthalmos occurred in 2/25 patients with small/moderate defects and 5/6 patients with large defects or multiple orbital wall fractures.
- Scar tissue weakness after PDS resorption contributed to inadequate orbital volume support and enophthalmos, even in moderate defects.
- Diplopia was reported in 8 patients with extreme gaze limitations and 2 patients with significant diplopia.
Conclusions:
- Polydioxanone implants are suitable for reconstructing small to moderate orbital floor defects (up to 2.5 cm²) to prevent enophthalmos.
- PDS implants should be reserved for cases without massive orbital fat herniation due to potential scar weakness.
- The long-term functional outcome can be influenced by the integrity of the scar formed after PDS implant resorption.