Comparison of Absorbable Mesh Plate versus Titanium-Dynamic Mesh Plate in Reconstruction of Blow-Out Fracture: An Analysis of Long-Term Outcomes

Abstract

Background: A blow-out fracture is one of the most common facial injuries in midface trauma. Orbital wall reconstruction is extremely important because it can cause various functional and aesthetic sequelae. Although many materials are available, there are no uniformly accepted guidelines regarding material selection for orbital wall reconstruction.

Methods: From January 2007 to August 2012, a total of 78 patients with blow-out fractures were analyzed. 36 patients received absorbable mesh plates, and 42 patients received titanium-dynamic mesh plates. Both groups were retrospectively evaluated for therapeutic efficacy and safety according to the incidence of three different complications: enophthalmos, extraocular movement impairment, and diplopia.

Results: For all groups (inferior wall fracture group, medial wall fractrue group, and combined inferomedial wall fracture group), there were improvements in the incidence of each complication regardless of implant types. Moreover, a significant improvement of enophthalmos occurred for both types of implants in group 1 (inferior wall fracture group). However, we found no statistically significant differences of efficacy or complication rate in every groups between both implant types.

Conclusions: Both types of implants showed good results without significant differences in long-term follow up, even though we expected the higher recurrent enophthalmos rate in patients with absorbable plate. In conclusion, both types seem to be equally effective and safe for orbital wall reconstruction. In particular, both implant types significantly improve the incidence of enophthalmos in cases of inferior orbital wall fractures.

Keywords: Absorbable implants; Orbital fractures; Orbital implants; Titanium.

Fig. 1

Difference of enophthalmos incidence in group 1 Significant improvements in enophthalmos are observable after surgical repair in both implant types within group 1 (P<0.05). However, both implant types showed no significant difference between themselves.

Fig. 2

Coronal image of 3-dimensional computed tomography (A) Preoperative view of medial wall defect. Note on the herniated soft tissue through lamina papyracea (red circle). (B) Immediate postoperative view. Note on the absorbable plate and well-reducted soft tissue (red arrow). (C) 13 months after orbital wall reconstruction, the absorbable plate was fully resorbed, and the fibrous tissue substituted the medial orbital wall (red arrow).