RECONSTRUCTION OF ORBITAL FLOOR FRACTURES WITH BIOACTIVE GLASS (S53P4)

Successful repair of fractures of the orbital and maxillary zygomatic complex has four prerequisities as through understanding of the regional anatomy; an accurate diagnosis; an unimbedded exposure, and in some cases rigid fixation of fracture with orbital for restoration of the premorbid form.

Material and methods: A retrospective case series of 50 patients with bioactive implants (BG implants) of S53P4 was carried out from 1992 to 1998 at the ENT-clinic of Turku University Central Hospital. All patients diagnosed as having complex maxillary fractures with orbital floor fractures or a large blow-out fracture. All subjects underwent a transconjunctival or subciliar approach with lateral canthotomy. After prolapsed orbital contents were elevated back into the orbit the BG implant was placed over the defect.

Results: On follow-up examinations, none of the 50 patients with BG-implants presented with any evidence of orbital dystopia or complications relating to the implant. Four patients (10%) had after surgery infraorbital nerve paresthesia and one etropium. Among the all control cases there were three cases (6%) of persistent diplopia and in one case we have removed the BG-implant three months after surgery. Postoperative computed tomographic scans showed adequate maintenance of orbital and maxillary sinus volume without and evidence of resorption of the BG implant. Four patients (10%) had persistent enophthalmos without any evidence of diplopia.

Summary: BG implants are promising and well tolerated material for the repair of orbital floor fractures. Compared to conventional methods, they carry less morbidity as no donor operation is needed.