Surgical Correction of Diplopia in Orbital Fracture: Influence of Material and Design

Purpose: The purpose of this study is to compare the association of diplopia after orbital fracture repair using titanium mesh and high-density polyethylene-coated titanium mesh. Materials and Methods: Retrospective review of records of consecutive patients who presented for primary/secondary correction of orbital fracture attending author's institute was done. Patients attending the institution between January 2013 and December 2017 (5 years' period) fulfilling the inclusion and exclusion criteria were included for this study. Results: In all, 44 patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The mean age was 31.86 ± 9.1 years and the mean period of follow-up was 9.37 ± 2.1 months postoperatively, with a range of 6.5–24 months. There were 65.91% males, and the most common etiology was road traffic accident (50%). In all, 11 (25%) cases had postoperative diplopia. Of the 11 cases that had diplopia, 6 had Class 1 and 5 had Class 2 diplopia. Of these 11 cases, 8 cases had completion or partial resolution of diplopia by the end of 8 weeks' period, and in 3 cases, it persisted even after 3 months of care. The occurrence of diplopia was compared by demographic factor using Chi-square test, and the mesh type was only statistically significant (P = 0.026). Discussion: The present study indicates that both types of mesh provide reliable, clinically better results. However, with passage of time, it was clinically observed that removing uncoated mesh poses extreme difficulty by the adherences and growth penetrating the meshes. In certain instances, clinically, it was observed that such adhesions may be a cause of compromise of eyeball movement. Conclusion: Noncoated titanium orbital implants may lead to the adherence of orbital and periorbital structures, resulting in restrictive diplopia. High-density polyethylene-coated titanium mesh shows better performance as compared to noncoated mesh in preventing adherence situations.

[1]  S. Merbs,et al.  Orbital fracture repair outcomes with preformed titanium mesh implants and comparison to porous polyethylene coated titanium sheets. , 2017, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[2]  Xianqun Fan,et al.  Postoperative Improvement of Diplopia and Extraocular Muscle Movement in Patients With Reconstructive Surgeries for Orbital Floor Fractures. , 2016, The Journal of craniofacial surgery.

[3]  S. Balaji.  Blowout fracture-orbital floor reconstruction using costochondral cartilage causing pain, warping, and diplopia , 2015, Annals of maxillofacial surgery.

[4]  B. Sloan,et al.  Orbital Adherence with Titanium Mesh Floor Implants: A Review of 10 Cases , 2013, Orbit.

[5]  S. Balaji.  Residual diplopia in treated orbital bone fractures , 2013, Annals of maxillofacial surgery.

[6]  W. Nunery,et al.  Orbital Adherence Syndrome Secondary to Titanium Implant Material , 2009, Ophthalmic plastic and reconstructive surgery.

[7]  Yinghui Tan,et al.  Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh. , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[8]  T. Teknos,et al.  Traumatic Optic Neuropathy Complicating Facial Fracture Repair , 1997, The Journal of craniofacial surgery.

[9]  A. Bluhm.  Associated injuries in facial fractures: Review of 839 patients , 1994 .

[10]  G. Dutton,et al.  The characteristics of midfacial fractures and the association with ocular injury: a prospective study. , 1991, The British journal of oral & maxillofacial surgery.

[11]  W. Treffers,et al.  Ocular injuries associated with fractures involving the orbit. , 1988, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.