CT Observation of Alloplastic Materials Used in Blow Out Fracture

Lee, Won; Kang, Dong Hee

Abstract

PURPOSE
Distinguishing different types of implants and assessing the position and size of implants by radiologic exam after orbital wall reconstruction is important in determining the surgery outcome and forecasting prognosis. We observed time-dependent density changes in three types of implants(porous polyethylene, resorbing plate and titanium mesh plate) by performing facial bone CT after orbital wall reconstructions.
METHODS
A total of 32 patients, who had underwent orbital wall fracture surgery from October 2006 to March 2009 and received facial bone CT as outpatients at 1 post-operative year were included in the study. Follow-up facial bone CT was performed on the patients pre-operatively, 1 month post-operatively, and 1 year post-operatively to observe the status of the orbital implants. Medpor(R)(Porex Surgical, Inc., Newnan, Ga.) was used as porous polyethylene and followed-up in 14 cases; for resorbing plate, Synthes mesh plate(Synthes, Oberdorf, Switzerland) was used in the reconstruction, and followed-up in 11 cases; and titanium mesh plate usage was followed-up in 7 cases. Computed tomographic scan(CT) and water's view were done for radiography, and hounsfield unit(HU) was used to compare density of those facial bone CT. Wilcoxon signed rank test was applied to statistically verify measurement difference in each group of hounsfield units.
RESULTS
Facial bone CT examination performed in 1 month post-operative showed that the density of porous polyethylene, resorbing plate and titanium mesh plate were -42.07, 105.67 and 539.48 on average, respectively. Among the three types of implants, titanium mesh plate showed the highest density due to its radiopaque feature. Following up the density of three types of implants in CT during 1 year after the orbital wall fracture surgery, the density of porous polyethylene increased in 10.52 House Field Units and the resorbing plate was decreased in 26.87 HouseField Units. There were no significant differences between densities in 1 month post-operatively and 1 year post-operatively in each group(p> or =0.05).
CONCLUSION
We performed facial bone CT on patients with orbital fractures during follow-up period, distinguishing the types of implants by the different concentration of implant density, and the densities showed little change even at 1 year post-operative. To observe how implant densities change in facial bone CT, further studies with longer follow-up periods should be carried out.