A comparative study of 2 implants used to repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] plate.

PURPOSE The purpose of this study was to compare our clinical findings on the use of autogenous bone grafts and bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] implants to repair inferior orbital wall defects. PATIENTS AND METHODS Thirty-nine patients who suffered orbital blow-out fractures with >or=2 cm2 bony defect in the inferior orbital wall took part in the study. Each inferior orbital wall was reconstructed using either an autogenous bone graft or a triangle form plate of P(L/DL)LA 70/30. Computed tomography scans were taken before the operation and at 2 and 36 weeks postoperatively. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, numbness, gaze restrictions, size of bony defect after treatment, bone growth, and implant resorption. A comparative study was carried out using chi2 test and the Fisher exact test. We considered P < .05 to be statistically significant. RESULTS The clinical outcome was excellent in 19 of the 24 (79%) cases treated with autogenous bone grafts and in 13 of the 15 (87%) cases treated with P(L/DL)LA 70/30. No statistically significant differences were found between the 2 groups in overall type or number of complications. The most frequent type of complication found in both groups was enophthalmos, with 5 cases (bone graft, 3; P(L/DL)LA plates, 2). Diplopia was the second most frequent type of complication; however, both complications caused no need for the removal of the implants in either group. CONCLUSION Autogenous bone grafts and P(L/DL)LA 70/30 implant plates do not present statistically significant differences in the parameters studied. Taking into account the availability and the advantages of P(L/DL)LA 70/30 implants when compared with autogenous bone grafts, our results allow us to conclude that there is no compromise regarding successful bridging of orbital floor defects using biodegradable P(L/DL)LA 70/30 osteosyntheses.

[1]  R. Kubale,et al.  Kernspintomographie der Orbitae bei posttraumatischen Motilitätsstörungen , 1995 .

[2]  P. Manson,et al.  Studies on Enophthalmos: II. The Measurement of Orbital Injuries and Their Treatment by Quantitative Computed Tomography , 1986, Plastic and reconstructive surgery.

[3]  P. Törmälä,et al.  Biodegradable semirigid plate and miniscrew fixation compared with rigid titanium fixation in experimental calvarial osteotomy. , 1999, Journal of neurosurgery.

[4]  B. Kaye.  Orbital floor repair with antral wall bone grafts. , 1966, Plastic and reconstructive surgery.

[5]  H. Niederdellmann,et al.  Long-term results after primary restoration of the orbital floor. , 1995, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[6]  J O Hollinger,et al.  Preliminary report on the osteogenic potential of a biodegradable copolymer of polyactide (PLA) and polyglycolide (PGA). , 1983, Journal of biomedical materials research.

[7]  A. H. Keeney,et al.  A review of 128 patients with orbital fractures. , 1974, American journal of ophthalmology.

[8]  Discrimination between artefacts and contractions in pressure signals from the gastrointestinal tract by pattern recognition method , 1996, Medical and Biological Engineering and Computing.

[9]  D E Cutright,et al.  The repair of fractures of the orbital floor using biodegradable polylactic acid. , 1972, Oral surgery, oral medicine, and oral pathology.

[10]  P. Holtom,et al.  Comparison of Anterior and Posterior Iliac Crest Bone Grafts in Terms of Harvest-Site Morbidity and Functional Outcomes , 2002, The Journal of bone and joint surgery. American volume.

[11]  B. Eppley,et al.  Resorbable Plate Fixation in Pediatric Craniofacial Surgery , 1997, Plastic and reconstructive surgery.

[12]  T. Waris,et al.  SR-PLLA and SR-PGA miniscrews: biodegradation and tissue reactions in the calvarium and dura mater. , 1999, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[13]  P. Törmälä,et al.  Processing and characterization of absorbable polylactide polymers for use in surgical implants. , 1994, Journal of Applied Biomaterials.

[14]  R. Mathog,et al.  A comparison of parietal and iliac crest bone grafts for orbital reconstruction. , 2002, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[15]  Fred Leonard,et al.  Polylactic Acid for Surgical Implants , 1966 .

[16]  J. D. Visscher,et al.  Medial Orbital Wall Fracture with Enophthalmos , 1988 .

[17]  P. Manson,et al.  Bone‐Graft Reconstruction of the Monkey Orbital Floor with Iliac Grafts and Titanium Mesh Plates: A Histometric Study , 1993, Plastic and reconstructive surgery.

[18]  M. Kallioinen,et al.  Consolidation of Craniotomy Lines after Resorbable Polylactide and Titanium Plating: A Comparative Experimental Study in Sheep , 1998, Plastic and reconstructive surgery.

[19]  C. Lindqvist,et al.  Bioresorbable poly-L/DL-lactide (P[L/DL]LA 70/30) plates are reliable for repairing large inferior orbital wall bony defects: a pilot study. , 2006, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[20]  L. Manfré,et al.  Orbital “blow-in” fracture: MRI , 2004, Neuroradiology.

[21]  A. Putterman.  Management of blow out fractures of the orbital floor. III. The conservative approach. , 1991, Survey of ophthalmology.

[22]  I M Brook,et al.  Self-reinforced polyglycolic acid membrane: a bioresorbable material for orbital floor repair. Initial clinical report. , 1995, The British journal of oral & maxillofacial surgery.

[23]  C. Lindqvist,et al.  Bioresorbable poly-L/DL-lactide (P[L/DL]LA 70/30) plates are reliable for repairing large inferior orbital wall bony defects: a pilot study. , 2006 .

[24]  O. Böstman.  Intense granulomatous inflammatory lesions associated with absorbable internal fixation devices made of polyglycolide in ankle fractures. , 1992, Clinical orthopaedics and related research.

[25]  P. Gullane,et al.  The Free Flap and Plate in Oromandibular Reconstruction: Long‐Term Review and Indications , 1995, Plastic and reconstructive surgery.

[26]  C. Lindqvist,et al.  Reconstruction of orbital floor with polydioxanone plate. , 1991, International journal of oral and maxillofacial surgery.

[27]  R. Rončević,et al.  Experience with various procedures in the treatment of orbital floor fractures. , 1981, Journal of maxillofacial surgery.

[28]  F W Cordewener,et al.  Poly(L-lactide) implants for repair of human orbital floor defects: clinical and magnetic resonance imaging evaluation of long-term results. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[29]  T. Albert,et al.  Physical and monetary costs associated with autogenous bone graft harvesting. , 2003, American journal of orthopedics.

[30]  J. Converse,et al.  Enophthalmos and diplopia in fractures of the orbital floor , 1956 .

[31]  Nureddin Ashammakhi,et al.  Self-reinforced bioresorbable poly-L/DL-lactide [SR-P(L/DL)LA] 70/30 miniplates and miniscrews are reliable for fixation of anterior mandibular fractures: a pilot study. , 2004, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[32]  M. Kellomäki,et al.  Orbital floor reconstruction with poly-L/D-lactide implants: clinical, radiological and immunohistochemical study in sheep. , 2004, International journal of oral and maxillofacial surgery.

[33]  Banwart Jc,et al.  Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. , 1995 .

[34]  R. Gockeln,et al.  Autogene Knochentransplantate zur Versorgung der traumatisch geschädigten Orbita Funktionelle und ästhetische Ergebnisse in 42 Fällen , 2001, Der Ophthalmologe.

[35]  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.

[36]  K. Krzystkowa,et al.  Blow-out fracture of the orbit. Diagnostic and therapeutic considerations, and results in 90 patients treated. , 1982, Journal of maxillofacial surgery.

[37]  O Salonen,et al.  Effectiveness of operative treatment of internal orbital wall fracture with polydioxanone implant. , 2001, International journal of oral and maxillofacial surgery.