Depending on the amount and severity of dislocation around the course of the infraorbital nerve, decompression might be indicated. This complicated anatomy makes repair and reconstruction of orbital. Incision choice, orbital volume restoration, appropriate orbital floor reconstruction, and permanent or temporary lower eyelid suspension during the primary surgery can all significantly impact the development of long. Outcomes of orbital floor reconstruction after extensive. Our aim was to compare the outcomes and complications of resorbable implants and permanent implants in orbital floor fracture repair. For traumatic defects of the orbital floor, reconstruction using a polyglactin 910pds.
Some implants are available with a barrier surface to prevent tissue ingrowth when necessary. Comprehensive solutions for orbital floor repair and reconstruction 2 pages. Orbital floor fractures are the most common traumatic fractures in the facial skeleton. Costochondral graft for large orbital defects in floor. Pdf orbital floor fracture reconstruction using conchal. Original article reconstruction of orbital blowout fractures using medpor titanium mesh implants xiaohui han, shunhai yang, zhizhang dong, wangqiang feng department of ophthalmology, the second affiliated hospital of wenzhou medical university, wenzhou 325000, china.
The goal of surgical repair in orbital floor fractures is twofold. Computerguided orbital reconstruction to improve outcomes. Rapid prototype 3dimensional biomodel of an orbit exhibiting orbital floor and medial wall defects. These findings support the approach of delaying orbital floor reconstruction in cases of silent sinus syndrome treated with sinus reventilation, as such reconstruction may prove unnecessary over time. Intraoperative navigationassisted surgical orbital floor. The surgical treatment involved orbital floor reconstruction with a titanium mesh and under general anesthesia. Bone grafts for the orbital floor have long been considered the standard treatment for orbital fracture repair. Nineteen patients who underwent orbital floor reconstruction with individual titanium mesh were included in this study. The ultimate goals are the reconstruction of the bony orbital defect with restoration of anatomy, volume, function, and esthetics. Materials to facilitate orbital reconstruction and soft. Internal orbital fractures in the pediatric age group. Therefore, a conventional technique that preoperatively creates orbital reconstruction materials on the basis. The purpose of internal orbit floor reconstruction is the anatomical true to.
The occurrence of mydriasis during orbital floor fracture reconstruction may cause significant. The choice of the ideal material for reconstruction of orbital floor and walls remains highly controversial. Pdf the medial wall and floor of the bony orbit are frequently fractured. Many materials, from different sources, have been described for that task. If desired, medpor material may be cut and shaped to fit the patient needs and your preferences. Case report comparative study of enophthalmos treatment with titanium mesh combined with absorbable implant vs. Relatively new in orbital floor repair is the use of nylon foil, a nonporous poly amide. We conducted a prospective, controlled, blinded pilot study to demonstrate that repair of induced rabbit orbital floor fractures with surgisis es cook biotech inc, west lafayette, ind provides adequate orbital content support while promoting. Automatic reconstruction of the orbital floor and the.
Trigeminocardiac reflex during orbital floor reconstruction. Injuries to the eye socket may result in an orbital fracture that requires reconstruction. Silent sinus syndrome describes an indolent and chronic disease characterized by atelectasis of the maxillary sinus due to obstruction of the ostium. Early decompression is favorable for neural restitution. Con anomalies branchial cleft cpt code surgery con anomalies branchial cleft pdf preseptal subtarsal approach for. Many specialists encounter and treat orbital fractures. Add to mymedicalexpo favorites requestbuttons catalog excerpts. The orbital floor, which forms the roof of the maxillary sinus, slopes. In this video kevin dotremont explains how to do an automatic reconstruction of the orbital floor and the maxillary sinus for craniomaxillofacial applications using. When it comes to surgical repair of orbital floor fractures, the consensus among oculoplastic specialists is that less is often more. Trumatch cmf titanium 3dprinted orbital plates matrixmidface preformed orbital plates synpor porous polyethylene orbital implants depuy synthes part of the family of companies. A technical video illustrating the key steps in orbital repair. Management of orbital complications in palatomaxillary. Objectives 1 to describe repair of complex orbital fractures using computer planning with preoperative.
Designed from ctscan data, the threedimensional implants closely approximate the topographical anatomy of the human orbital floor and medial wall, to provide accurate reconstruction even after significant twowall fractures. Cosmetic and reconstructive procedures page 4 of 7 unitedhealthcare oxford clinical policy effective 01012018 19962018, oxford health plans, llc cpt code description 21179 reconstruction, entire or majority of forehead andor supraorbital rims. Additionally, complete reconstruction of the orbital floor is difficult in patients with massive comminution. Orbital exenteration may be reserved for those tumors that encroach on the intraorbital contents in which more conservative surgery would violate oncologic margins or yield a. Orbital reconstruction is very difficult when the transition areas between the orbital floor and the medial wall is missing. A novel use of biomaterial implants for reconstruction of. Anatomical reconstruction of medial wall and orbital floor. Medpor titanmaxorbital floor and wall the wider titanium mesh and extensions on the medpor titan max orbital floor and wall ofw implant provides the surgeon with an alternative to other repair materials for large orbital floor fractures andor combined fractures of the orbital floor and medial wall. Hardly any other field in craniomaxillofacial surgery has changed so much in terms of diagnostics, biomaterial selection for reconstruction, surgical techniques including approaches and quality control. This script was created with an older version of mimics i think 18.
Orbital floor reconstruction in silent sinus syndrome. Pdf orbital floor reconstruction using porcine small intestinal submucosa howard krein academia. Longterm followup of blowout fractures of the orbital. Bone grafts were chosen for large defects, comminuted fractures or if other reconstruction eg, sinus was required. A study was undertaken to evaluate the safety of magnetic resonance imaging mri of metallic implants used in cranio orbital reconstruction stainless steel wire and titanium and vitallium plates and also to compare the degree of artifact created on computed tomographic ct. Posttraumatic orbital reconstruction is one of the most fascinating fields in reconstructive craniomaxillofacial surgery. Orbit reconstruction an overview sciencedirect topics. Long term complications of orbital floor fracture repair. Con anomalies branchial cleft cpt code surgery orbital floor fractures intraoperative imaging changes.
Reconstruction of orbital floor for treatment of a pure blowout fracture. Pdf we report our experience with the repair of the orbital floor fractures and present new technical findings. This is a retrospective study with the aim to evaluate orbital floor reconstruction with autogenous bone and alloplastic materials consisting of medpor, medpor titan, titanium, and resorbable plates. Introduction the unique and complex anatomy of the orbit, unless prebent plates are used, requires significant contouring of the implants to restore the proper anatomy. Orbital floor symmetry after maxillectomy and orbital. Pdf materials used for reconstruction after orbital. The resection of the orbital floor in maxillectomy surgery mandates either orbital exenteration or reconstruction to maintain orbital function. Many fractures of the orbit, a common occurrence with facial trauma, never require surgery, which is customarily performed in patients with. Outcomes of orbital floor reconstruction after extensive maxillectomy using the computerassisted fabricated individual titanium mesh technique q6 wenbo zhang, md,chi mao, md,yxiaojing liu, md,zchuanbin guo, md, phd,x guangyan yu, md, dds,kand xin peng, md, ddspurpose.
Materials to facilitate orbital reconstruction and soft tissue filling in posttraumatic orbital deformaties lingxiao ye, xiaoming sun, yuguang zhang, ying zhang department of plastic and reconstructive surgery, ninth peoples hospital affiliated to the medical school of shanghai jiao tong university, shanghai 200011, china. Original article reconstruction of orbital blowout. This retrospective study evaluated the clinical outcome after reconstruction of traumatic orbital floor defects using a polyglactin 910pds implant ethisorb. We evaluated 101 patients with pure blowout fracture or concomitant with zygomatic maxillary fracture. Reconstruction of the orbital floor has to respect the course of the infraorbital nerve in the orbital floor. The other option is to use the preformed orbital plate. Whether the orbit reconstruction is indicated, natural and synthetic materials are available.
Anatomical reconstruction of medial wall and orbital floor fractures. Medpor is designed to accept screws and plates without cracking, providing you with more flexibility in fixation options and placement. Clinical management and reconstruction of isolated orbital. Biomaterials for reconstruction of the internal orbit dr. Postoperative computed tomography scans recorded after threedimensional 3d reconstruction were used to evaluate the symmetry of the orbital floor, including orbital floor height, orbital floor eminence, globe projection, orbital volume, and surface. Under these circumstances, the surgeon may reconstruct the defect using two separate plates, one for the medial wall and one for the orbital floor.
A clinically significant orbital floor defect will be defined as a gap remaining after reduction or elevation of orbital floor fracture fragments that requires a semirigid implant to avoid postoperative enophthalmos or orbital dystopia. Pdf orbital floor reconstruction using porcine small. Park, md, is a dual boardcertified facial plastic surgeon and ear, nose, and throat otolaryngology specialist who offers orbital floor reconstruction for residents of long island, queens and surrounding communities in new york. Mydriasis during orbital floor fracture reconstruction. Orbital reconstruction for orbit, orbital floor fracture. Seventy patients with isolated blowout fractures of the orbital floor resulting in defect sizes of up to 2. A study of orbital reconstruction with lyophilized dura on 55 patients demonstrated a oneyear enophthalmos rate of 5. A novel use of biomaterial implants for reconstruction of orbital floor fracture. The principle of this approach requires an appropriate. Anatomic orbital floor plate, large recommended for orbital floor defects with medial and lateral wall involvement and reconstruction of tumor resections medial wing clears lacrimal duct mshaped cutout designates medial wing anatomic orbital floor plate, small anatomic orbital floor plate, medium anatomic orbital floor plate, large. Costochondral graft is a suitable choice when orbital reconstruction is indicated.
This script automatically fills in holes in the orbital floor as well as in the maxillar sinuses. Comprehensive solutions for orbital floor repair and. Orbital floor reconstruction long island, ny queens, ny. The resultant collapse of the maxillary sinus is associated with inferior bowing of the orbital floor that increases the effective orbital volume. Although orbital reconstruction using implant materials is effective, it is difficult to assess the accuracy during surgery. Selection of materials for orbital floor reconstruction. Objective to evaluate the use of autogenous maxillary bone for the repair of orbital floor defects secondary to blunt facial trauma design retrospective case series of 41 patients with a mean followup of 1. Blunt trauma to the orbital rim is a frequent cause of orbital floor and medial orbital wall fractures.
Materials used for reconstruction after orbital floor fracture. Orbital reconstruction for orbit, combined fracture. Our case series demonstrates that dynamic changes in orbital floor position can occur after sinus reventilation. A retrospective comparative case series of all orbital floor fracture repair cases 158 eyes from 1983 to 1998 was done. Current strategies in posttraumatic orbital reconstruction. Resorbable alloplastic materials are used in many surgical applications. Orbital floor reconstruction with pre contoured titanium. Synthetic prostheses were tailored to the orbital floor in clinically significant fractures. Reconstruction of orbital floor fractures with maxillary. Nylon foil has provided favourable results in preliminary. Automated orbital floor and maxillar sinus reconstruction.
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