Skip to main content

Advertisement

SpringerLink
Log in

Alloplastic reconstruction of orbital floor fractures: a systematic review and pooled outcomes analysis

  • Review
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Orbital floor defects from traumatic injuries can be successfully repaired surgically utilizing alloplastic implants. The objective of this study was to conduct a comprehensive systematic review of alloplastic implant materials utilized in the repair of orbital floor fractures stratified by material type, indication for surgery, and outcomes in all reported cases to date.

Methods

A comprehensive systematic review of published literature on alloplastic periorbital implant studies was conducted utilizing Medline/PubMed database without timeframe limitations. Articles were reviewed in full by multiple authors and outcomes data were collected.

Results

A total of 11 studies (n = 585 patients) were identified to meet the inclusion criteria. Overall, 25 total surgical complications (4.3%) were noted, including infection, inflammation, graft migration or explantation, and hematoma. Overall, porous polyethylene (PPE) implants were associated with the highest rate of infection (2.0%) compared with all other implant types analyzed. Poly-l-lactic acid (PLLA) implants were associated with the highest rate of graft explantation (5.9%). Explantation was required in a total 0.6% of all implants (n = 3).

Conclusions

Alloplastic implants are a reliable means of reconstructing the orbital floor following trauma. It is imperative for surgeons to understand the relative risks for each type of implant to develop postoperative complications in order to optimize outcomes.

Level of evidence: Level III, therapeutic study

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Smith B, Regan WF (1957) Blow-out fracture of the orbit*: mechanism and correction of internal orbital fracture. Am J Ophthalmol 44(6):733–739

    Article  CAS  Google Scholar 

  2. Fujino T, Makino K (1980) Entrapment mechanism and ocular injury in orbital blowout fracture. Plast Reconstr Surg 65(5):571–576

    Article  CAS  Google Scholar 

  3. Burnstine MA (2002) Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis1. Ophthalmology. 109(7):1207–1210

    Article  Google Scholar 

  4. Cole P, Boyd V, Banerji S, Hollier LH Jr (2007) Comprehensive management of orbital fractures. Plast Reconstr Surg 120(7):57S–63S

    Article  CAS  Google Scholar 

  5. Mok D, Lessard L, Cordoba C, Harris PG, Nikolis A (2004) A review of materials currently used in orbital floor reconstruction. Can J Plastic Surg 12(3):134–140

    Article  Google Scholar 

  6. Chowdhury K, Krause GE (1998) Selection of materials for orbital floor reconstruction. Arch Otolaryngol Head Neck Surg 124(12):1398–1401

    Article  CAS  Google Scholar 

  7. Iatrou I, Theologie-Lygidakis N, Angelopoulos A (2001) Use of membrane and bone grafts in the reconstruction of orbital fractures. Oral Surg Oral Me Oral Pathol Oral Radiol Endod 91(3):281–286

    Article  CAS  Google Scholar 

  8. Johnson PE, Raftopoulos I (1999) In situ splitting of a rib graft for reconstruction of the orbital floor. Plast Reconstr Surg 103(6):1709–1711

    Article  CAS  Google Scholar 

  9. Mintz SM, Ettinger A, Schmakel T, Gleason MJ (1998) Contralateral coronoid process bone grafts for orbital floor reconstruction: an anatomic and clinical study. J Oral Maxillofac Surg 56(10):1140–1144

    Article  CAS  Google Scholar 

  10. Kakibuchi M, Fukuda K, Yamada N, Matsuda K, Kawai K, Kubo T, Sakagami M (2003) A simple method of harvesting a thin iliac bone graft for reconstruction of the orbital wall. Plast Reconstr Surg 111(2):961–962

    Article  Google Scholar 

  11. Skouteris CA, Sotereanos GC (1989) Donor site morbidity following harvesting of autogenous rib grafts. J Oral Maxillofac Surg 47(8):808–812

    Article  CAS  Google Scholar 

  12. Haug RH, Nuveen E, Bredbenner T (1999) An evaluation of the support provided by common internal orbital reconstruction materials. J Oral Maxillofac Surg 57(5):564–570

    Article  CAS  Google Scholar 

  13. Laxenaire A, Levy J, Blanchard P, Lerondeau J, Tesnier F, Scheffer P (1997) Complications of silastic implants used in orbital repair. Rev Stomatol Chir Maxillofac 98:96–99

    PubMed  Google Scholar 

  14. Klisovic DD, Katz SE, Lubow M (2002) The wayward implant: orbital silicone plate extrusion associated with squamous epithelial downgrowth and infection. Orbit. 21(2):149–154

    Article  Google Scholar 

  15. Dougherty WR, Wellisz T (1994) The natural history of alloplastic implants in orbital floor reconstruction: an animal model. J Craniofac Surg 5(1):26–32 discussion 33

    Article  CAS  Google Scholar 

  16. Cuzalina LA, Hlavacek MR (2009) Complications of facial implants. Oral Maxillofac Surg Clin North Am 21(1):91–104

    Article  Google Scholar 

  17. Baino F (2011) Biomaterials and implants for orbital floor repair. Acta Biomater 7(9):3248–3266

    Article  CAS  Google Scholar 

  18. Kirby EJ, Turner JB, Davenport DL, Vasconez HC (2011) Orbital floor fractures: outcomes of reconstruction. Ann Plast Surg 66(5):508–512

    Article  CAS  Google Scholar 

  19. Ellis E III, Tan Y (2003) Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh. J Oral Maxillofac Surg 61(4):442–453

    Article  Google Scholar 

  20. Kelly CP, Cohen AJ, Yavuzer R, Jackson IT (2005) Cranial bone grafting for orbital reconstruction: is it still the best? J Craniofac Surg 16(1):181–185

    Article  Google Scholar 

  21. Gear AJ, Lokeh A, Aldridge JH, Migliori MR, Benjamin CI, Schubert W (2002) Safety of titanium mesh for orbital reconstruction. Ann Plast Surg 48(1):1–9

    Article  Google Scholar 

  22. Yaremchuk MJ (2003) Facial skeletal reconstruction using porous polyethylene implants. Plast Reconstr Surg 111(6):1818–1827

    Article  Google Scholar 

  23. Rubin JP, Yaremchuk MJ (1997) Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 100(5):1336–1353

    Article  CAS  Google Scholar 

  24. Garibaldi DC, Iliff NT, Grant MP, Merbs SL (2007) Use of porous polyethylene with embedded titanium in orbital reconstruction: a review of 106 patients. Ophthalmic Plast Reconstr Surg 23(6):439–444

    Article  Google Scholar 

  25. Rubin PA, Popham JK, Bilyk JR, Shore JW (1994) Comparison of fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants. Ophthalmic Plast Reconstr Surg 10(2):96–103

    Article  CAS  Google Scholar 

  26. Mackenzie DJ, Arora B, Hansen J (1999) Orbital floor repair with titanium mesh screen. J Craniomaxillofac Trauma 5(3):9–16

    CAS  PubMed  Google Scholar 

  27. Nam SB, Bae YC, Moon JS, Kang YS (2006) Analysis of the postoperative outcome in 405 cases of orbital fracture using 2 synthetic orbital implants. Ann Plast Surg 56(3):263–267

    Article  CAS  Google Scholar 

  28. Elmazar H, Jackson IT, Degner D, Miyawaki T, Barakat K, Andrus L, Bradford M (2003) The efficacy of Gore-Tex vs. hydroxyapatite and bone graft in reconstruction of orbital floor defects. Eur J Plast Surg 25(7–8):362–368

    Article  Google Scholar 

  29. Park DJ, Garibaldi DC, Iliff NT, Grant MP, Merbs SL (2008) Smooth nylon foil (SupraFOIL) orbital implants in orbital fractures: a case series of 181 patients. Ophthalmic Plast Reconstr Surg 24(4):266–270

    Article  Google Scholar 

  30. Cordewener FW, Bos RR, Rozema FR, Houtman WA (1996) Poly (L-lactide) implants for repair of human orbital floor defects: clinical and magnetic resonance imaging evaluation of long-term results. J Oral Maxillofac Surg 54(1):9–13

    Article  CAS  Google Scholar 

  31. Balogh C, Lucas R, Kraft T, Breton P, Freidel M (2001) Lactic acid polymer implants in the repair of traumatic defects of the orbital floor. Rev Stomatol Chir Maxillofac 102(2):109–114

    CAS  PubMed  Google Scholar 

  32. Bergsma JE, De Bruijn WC, Rozema FR, Bos RR, Boering G (1995) Late degradation tissue response to poly (L-lactide) bone plates and screws. Biomaterials. 16(1):25–31

    Article  CAS  Google Scholar 

  33. Jank S, Emshoff R, Schuchter B, Strobl H, Brandlmaier I, Norer B (2003) Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95(1):16–22

    Article  Google Scholar 

  34. Büchel P, Rahal A, Seto I, Iizuka T (2005) Reconstruction of orbital floor fracture with polyglactin 910/polydioxanon patch (ethisorb): a retrospective study. J Oral Maxillofac Surg 63(5):646–650

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Michelle K. Higgins, PhD from the Mayo Clinic School of Medicine in Scottsdale, AZ for her methodological input.

Author information

Authors and Affiliations

  1. University of Utah Health, Salt Lake City, UT, USA

    Jeremie D. Oliver

  2. Mayo Clinic, Mayo Clinic School of Medicine, Rochester, MN, USA

    Elias S. Saba, Nikita Gupta & Tina M. Hendricks

  3. Mayo Clinic, Mayo Clinic School of Medicine, Scottsdale, AZ, USA

    Elias S. Saba, Nikita Gupta & Tina M. Hendricks

  4. Division of Pediatric Plastic and Reconstructive Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Davinder J. Singh

Authors
  1. Jeremie D. Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elias S. Saba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikita Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tina M. Hendricks
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Davinder J. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeremie D. Oliver.

Ethics declarations

Conflict of interest

Jeremie D Oliver, Elias S Saba, Nikita Gupta, Tina M Hendricks, and Davinder J Singh declare that they have no conflict of interest.

Statement of human and animal rights, or ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oliver, J.D., Saba, E.S., Gupta, N. et al. Alloplastic reconstruction of orbital floor fractures: a systematic review and pooled outcomes analysis. Eur J Plast Surg 43, 109–116 (2020). https://doi.org/10.1007/s00238-019-01614-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-019-01614-x

Keywords

Search

Navigation