The clinical study of medpor in blowout fracture treatment (one hundred patients)

Byeon, Jun Hee

Abstract

The treatment and the operation timing for blowout fracture have been controversial, but recently most surgeons advocate early operative treatment for better postoperative results and decreased incidences of diplopia and enophthalmos. This is a retrospective study on early surgical reconstruction of the blowout fracture with ?? (porous polyethlene) implant. From Dec. 1993 to Aug. 1998, 100 patients (83 males and 17 frmales) with blowout fracture were operated using Medpor. The indications for operation were positive symptoms and signs (diplopia, enophthalmos, limitation in forced duction test, and Hess test)or, although without these, fractures larger than 1 cm in diameter proven with orbital CT. The open reduction was done by subciliary or transconjunctival approach and the bony defect was covered with Medpor (thickness 0.85 mm, pore size-over 100 m). The results were evaluated from the 100 patients who have been followed up over 3 months. The average follow-up time was 22 months, with a range of 3 to 47 months. Diplopia, restricted ocular motility and enophthalmos were preoperatively documented in 67, 34 and 14 percent of patients, respectively. Among these 67 patients of diplopia, 63 patients recovered completely and 4 patients, who were operated after 3 weeks after injury, complained minimal diplopia even in postoperative 6 months. Six of 34 patients who were noted of preoperative extraocular muscle limitation showed some residual limitation of inferior rectus or inferior oblique muscle over postoperative 6 months. Two of 14 patients who were noted of enophthalmos were kept mild enophthalmos over postoperative 6 months. With the use of ?? implant, the operation time was shortened compared with the use of the autogenous bone graft and there were no early and late complications due to the Medpor as a synthetic material. Untreated blowout fracture frequently results in delayed diplopia, enophthalmos, or strabismus although preoperative symptoms and signs are absent or minimal. Therefore the operation should be done as soon as possible. Medpor, porous polyethlene implant, is one of the most suitble material for reconstruction of the fractured orbital wall because of its long-term stability, high tensile strength, easy contouring, a virtual lack of surrounding soft-tissue reaction, and low infection rate, and that porous structure is permitted ingrowth of vascular and osseous tissue.