Bony realignment after surgical removal of orbital implantation cysts: A case series

Orbital cyst formation following previous orbital fracture surgery is an uncommon complication, yet it poses a significant concern related to permanent implant use. This complication may result in a pronounced mass effect that leads to deformation of the orbital bony walls. We present the three cases of orbital implantation cysts associated with orbital wall deformity, where bony alignment normalized after complete cyst removal. Patients exhibited ocular symptoms, including proptosis, diplopia, and hyperglobus. Surgical management involved total resection of the orbital cyst, removal of the prior implant, and placement of a new absorbable implant. Serial orbital computed tomography imaging performed over a 2-year postoperative period revealed progressive restoration of the orbital wall contour through ongoing bony realignment, with no evidence of implant migration or cyst recurrence. To the best of our knowledge, these cases provide the first documented radiological proof that bony remodeling after mass effect from an orbital implantation cyst is reversible, indicating that bone deformation caused by chronic compression can return to normal anatomy. This series underscores the necessity of thorough cyst excision and highlights the potential for anatomical correction following surgical intervention.