Medial orbital wall reconstruction with porous polyethylene by using a transconjunctival approach with a caruncular extension

Chieh Chou, Yur Ren Kuo, Chien Chang Chen, Cheng Sheng Lai, Sin Daw Lin, Shu Hung Huang, Su Shin Lee*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

12 Scopus citations

Abstract

Background: The reported rate of isolated medial orbital wall fractures varies widely but has been found to be as high as 55% of all orbital fractures. Identifying and repairing medial orbitalwall defects by using appropriate materials improves patient outcome considerably; however, most related research has focused on orbital floor defect management rather than medial orbitalwall treatment, and no consensus on repairing medial orbital wall fractures exists. Furthermore, medial orbitalwall fracture is a main cause of posttraumatic enophthalmos. In this study, we introduce a modified surgical technique for repairing large medial wall fractures stably, also reviewed relevant literature and established an algorithm for managing medial orbital wall fractures. Methods:We reviewed the outcomes of facial trauma patients who underwent facial bone reduction and internal fixation surgery in our hospital between October 1, 2010, andOctober 1, 2013. The patientswere all treatedmedial orbital wall reconstruction with porous polyethylene by using a transconjunctival approach with a caruncular extension for large medial orbital wall fractures. Medical records and radiologic images of the patients were reviewed retrospectively. The outcomes evaluated were trauma mechanism, clinical findings of ocular injury, preoperative and postoperative ocular symptoms, degree of enophthalmos, and orbital volume restoration after surgery. Results: Transconjunctival approach with a caruncular extension was performed without any complications. The incidence of diplopia was 47.4% and enophthalmos (2 mm) was 31.6%, with no significant diplopia and enophthalmos after surgery. Patients were symptom-free on follow-up. The average enophthalmos was successfully corrected from 0.88 mm preoperatively to 0.26 mm and orbital volume was corrected from 26.22 to 22.99 cm3 after surgery; these results also showed P less than 0.001. Conclusions: The current results suggest that the proposed method of medial orbitalwall reconstruction, in which porous polyethylene is implanted by using a transconjunctival approach with a caruncular extension, yields favorable outcomes. The approach facilitates a wide visualization of the operative field, which provides sufficient working space for implant insertion and is consequently free from iatrogenic trauma or surgery-related complications.

Original languageEnglish
Pages (from-to)S89-S94
JournalAnnals of Plastic Surgery
Volume78
Issue number3
DOIs
StatePublished - 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Caruncular extension
  • Medial orbitalwall fracture
  • Porous polyethylene
  • Transconjunctival

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