Orbital Wall Reconstruction with Resorbable Polymeric Mesh

Kim, Jin Il; Park, Eun Soo; Tark, Min Seong; Jung, Sung Gyun; Kim, Yong Bae

Abstract

The goals of reconstruction of orbital blowout fracture are to restore continuity, to provide support of orbital contents and to prevent functional and anatomic defects. Various materials such as autogenous and alloplastic implants have been used to reconstruct the defect of orbital wall fracture. Autogenous implants such as bone and cartilage have the advantages of excellent biocompatibility and low rates of infection. On the other hand, they have the disadvantage of donor site morbidity. Alloplastic implants have potential risk of tissue inflammation and migration within orbit or anterior to the skin although they are easy to use without any disadvantages of donor site morbidity. To cover these disadvantages of various materials, we used the resorbable materials in mesh form(Biosorb FX(R)) in orbital wall reconstruction. Seventeen patients with blowout fracture defect were operated with 0.8mm thickness resorbable material in mesh form and fourteen of them were followed-up (Minimum, 9 months; maximum, 30 months). The results were satisfactory in most cases. Some of them showed minor problems for a short time; One patient had persistent 2mm enophthalmos, but no further surgical correction was required. Transient diplopia in four patients disappeared in two weeks. Lower eyelid swelling in two patients lasted for more than two weeks, but no inflammation, migration or extrusion of implants were observed. Resorbable materials allow initial sufficient stability and are gradually resorbed through the physiologic process. So no permanent implants that might affect facial growth, create interference with radiologic imaging, or be susceptible to infection and extrusion remain. Resorbable mesh plates we used are made of copolymers of Dextro(D)-polylactic acid and Levo(L)-polylactic in 30: 70 ratio. They were well tolerated by tissue, giving adequate support to healing of bone defect. During the follow-up period(mean 14 months), no significant problems were observed.