[Silastic implants and reconstruction of the orbital floor: review of twenty year's experience]

Fractures of the orbital floor still raise unresolved therapeutic problems concerning the operative indication or the type of material to be used during repair. For this purpose, surgeons have the choice between heterologous or autologous grafts, implants and numerous biomaterials. The authors conducted a retrospective study with a follow-up of 20 years of 137 patients treated in the department for a fracture of the orbital floor using a Silastic implant. The reoperation rate to remove the implant was 13.8%. Various complications were observed: dacryocystitis, migration of the implant to the skin and maxillary sinus, cutaneous fistula, persistent diplopia, orbito-sinus communication, periorbital cellulitis. In view of these complications, it appears preferable to modify the therapeutic approach and propose autotransplantation of the concha for defects less than 1.5 cm2 and autologous parietal bone graft for larger defects.