Combined Use of Titanium Mesh and Resorbable PLLA-PGA Implant in the Treatment of Large Orbital Floor Fractures

Background: A variety of alloplastic permanent and resorbable materials have been successfully used in orbital floor reconstruction; nevertheless, they both have shown disadvantages in the reconstruction of large orbital floor defects. We believe that, by combining both types of implants, the disadvantages could be diminished. Methods: This is a retrospective study that included all patients with large orbital floor defects (>2 x 2 cm), pure or in association with other facial fractures, treated in our service with the combined use of titanium mesh and the resorbable implant LactoSorb. Results: We included 20 patients, 7 had pure blowout fractures and the rest had other associated maxillofacial fractures. All of them had a large orbital floor defect with entrapment of periorbital tissue and herniation into the maxillary sinus. Mean hospital stay was 2 days, and our follow-up period was for at least 3 months. Seventeen patients had complete coverage of their floor defect with restoration of orbital volume, normal globe position, and full extraocular motility. We report 3 cases of enophthalmos and 2 cases of ectropion. Followup tomographic scans showed incomplete implant coverage of the orbital floor in 2 cases and a misplaced implant in the other. Subsequent operation was needed for correction. Conclusions: We believe that the combination of both implants is a good option for the reconstruction of large orbital floor defects. It takes full advantage of their intrinsic properties while at the same time lowers the disadvantages of their individual use. Complications were attributed to technical errors and not to the combination of both materials.