Intermediate Outcomes of Orbital Wall Reconstruction Using Different Alloplastic Materials: Which Is Ideal?

BACKGROUND

Despite the popularity and superiority of resorbable alloplastic materials in orbital fracture reconstruction, it is unclear whether the reconstructed wall is maintained after implant resorption. Unsintered hydroxyapatite/poly-L-lactide (u-HA/PLLA) is one such material, but it differs from conventional materials for the replacement of natural bones. This study investigated the intermediate-term safety and efficacy of u-HA/PLLA implants compared with those of implants made with other alloplastic materials.

METHODS

The authors retrospectively analyzed 240 eligible patients who underwent orbital fracture reconstruction with one alloplastic material between January of 2006 and October of 2018. Materials used for treatment were as follows: u-HA/PLLA sheet in 101 patients, u-HA/PLLA mesh in 38 patients, poly-L-lactic acid/poly-glycolic acid mesh in 47 patients, silicone sheet in 35 patients, and titanium mesh in 19 patients. Intermediate-term follow-up was performed for a median duration of 48.2 months. A chart review was performed. Postoperative complications and factors affecting them were studied. Reconstructed area deformities were assessed using computed tomography.

RESULTS

Postoperative complications occurred significantly more frequently in patients reconstructed with the silicone sheet than in those reconstructed with the u-HA/PLLA sheet. Deformities were found for the silicone sheet (28.6 percent) and poly-L-lactic acid/poly-glycolic acid mesh (31.9 percent). These deformity rates were significantly higher than those for the u-HA/PLLA sheet.

CONCLUSIONS

Compared with other alloplastic materials, u-HA/PLLA has low rates of postoperative complications and reconstructed area deformities. Because of its complete absorption, clinicians should consider using u-HA/PLLA as an alloplastic material for orbital wall reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.