Long-term clinical outcomes of isolated orbital floor fracture reconstruction using nonresorbable implants

There are no universally established guidelines for material selection in orbital wall fracture reconstruction. With an increasing preference for permanent implants, this study aimed to compare the long-term clinical outcomes of three different non-resorbable materials in reconstructing isolated orbital floor fractures.

A retrospective, interventional comparative study.

The medical records of patients with unilateral pure orbital floor fractures who underwent orbital reconstruction using non-resorbable alloplastic implants at two tertiary referral centers between January 2017 to December 2021 were reviewed. Cases with non-pure orbital floor blowout fractures and/or <2 years of follow-up were excluded. Patients were separated into three groups according to the implant material type: porous polyethylene (PPE) sheet, polypropylene (PP) mesh, and titanium (Ti) mesh. These groups were then retrospectively analyzed for clinical outcomes, implant-related complications, and patient's satisfaction.

Sixty-six patients met the inclusion criteria. Twenty-four patients (36.36%) received PPE sheets, 20 patients (30.3%) had PP mesh, and 22 patients (33.33%) received Ti mesh. At the 6-month postoperative visit, nine patients (40.9%) in the Ti mesh group experienced postoperative diplopia compared to six patients (30.0%) in the PP group and one patient (4.2%) in the PPE group (P < 0.047). Following the initial 6-month postoperative period, the PP group had more frequent postoperative enophthalmos compared to the other 2 groups. The total ocular motility restriction score was significantly lower in the Ti mesh group compared to the other 2 groups at all follow-up visits. Patient's satisfaction was significantly higher in the PPE group (median = 10, IQR = 1) compared to the PP (median = 8.5, IQR = 3) and Ti groups (median = 8, IQR = 3), P < 0.001. Reoperation was needed in seven patients (31.8%) in the Ti group, two patients (10%) in the PP group, and none in the PPE group.

The use of PPE orbital implants for the repair of isolated orbital floor fracture provides better long-term clinical outcomes compared to PP or Ti mesh and reduces the need for reoperation across all fracture sizes. Ti mesh has been associated with a higher frequency of unfavorable clinical outcomes and implant removal.