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Updated: Mar 29, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Comparison of Reconstructive Materials in Paediatric Orbital Fractures: A Systematic Review
Jane Chen1, Anton Sklavos1, Mustafa Mian2
1Department of Oral and Maxillofacial Surgery, Monash Health, 135 David Street, Dandenong, VIC 3175, Australia.
Insights
Choosing the right implant material for pediatric orbital fracture repair is crucial. Polymers and alloplasts show lower rates of late diplopia compared to other materials, but more research is needed.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Biomaterials Science
Background:
- Paediatric orbital fractures necessitate precise reconstruction to avoid lasting functional and aesthetic issues.
- Material selection for pediatric orbital fracture repair presents unique challenges due to anatomical and developmental factors specific to children.
- Current comparative data guiding implant material choices for pediatric orbital reconstruction are limited.
Purpose of the Study:
- To systematically review and compare the outcomes and complications of various implant materials used in paediatric orbital fracture reconstruction.
- To identify trends in material usage and associated sequelae in pediatric orbital fracture repair.
Main Methods:
- A systematic literature search was performed across PubMed, Scopus, Web of Science, and Embase up to February 2025.
- Studies reporting outcomes (diplopia, enophthalmos, restricted eye movements, material removal, return to theatre) for pediatric orbital fracture implants were included, adhering to PRISMA guidelines.
- Data from 54 studies involving 562 patients and 563 implants were analyzed, categorizing materials into polymers, alloplasts, autologous, allografts, xenografts, and metals.
Main Results:
- Polymers (n=169), alloplasts (n=167), and autologous (n=166) implants were most frequently used.
- Late postoperative diplopia rates were 7% for polymers and 6% for alloplasts, significantly lower than allografts (29%), xenografts (24%), and metals (33%).
- Infection, material removal, and return to theatre rates were low (1-4%) across all material groups; enophthalmos was highest in the autologous group (8%) but inconsistently reported.
Conclusions:
- Polymers and alloplasts appear to be favorable options for pediatric orbital fracture reconstruction regarding late diplopia.
- While short-term complications like infection and material removal are low across most materials, robust studies with standardized outcomes and follow-up are essential for evidence-based material selection.
- Further research is needed to establish definitive guidelines for optimal material choice in pediatric orbital reconstruction.
Abstract:
Paediatric orbital fractures require careful reconstruction to prevent long-term functional and aesthetic sequelae. Material selection is critical due to the anatomical and developmental considerations unique to children. Comparative data to guide decision making remain sparse and inconclusive. A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase (through February 2025), following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Studies reporting outcomes and/or complications associated with implant materials used in the reconstruction of paediatric orbital fractures were included. Outcomes included postoperative diplopia, enophthalmos, restriction of eye movements, removal of material, and return to theatre (RTT). In total, 54 studies encompassing a total of 562 patients and 563 implants were included. Polymers (n = 169), alloplasts (n = 167) and autologous (n = 166) implants were the most commonly used reconstructive material. Late postoperative diplopia occurred in 7% of polymers (12/169), 6% of alloplasts (10/167), 29% of allografts (6/21), 24% of xenografts (6/25) and 33% of metals (2/6). Reported enophthalmos was highest in the autologous group (8%) but was only reported in 34 of the 54 studies. Infection, removal of implant material and RTT were low across all groups (1-4%). No donor site morbidity was reported. Robust studies with standardised outcomes and adequate follow-up are needed to inform evidence-based material selection in paediatric orbital reconstruction.
