OUTCOME FOLLOWING ORBITAL FLOOR FRACTURE RECONSTRUCTION USING SILASTIC IMPLANTS

Abstract

Background: Orbital floor fracture is typically present with peri-orbital ecchymosis, subconjunctival hemorrhage, enophthalmos and diplopia. The goals of reconstruction are to restore the volume and shape of the orbital cavity with autogenous or alloplastic materials. However, no gold standard exists for orbital implants to treat orbital floor fractures and remains controversial. Silicone was one of the most common biocompatible materials used for orbital floor reconstruction. Objective: The study aimed to evaluate the outcomes of patients reconstructed using silastic sheets in the case of orbital wall fractures. Methods: A multi-center, retrospective study of patients with orbital floor fractures was conducted from January 2010 to December 2019. Inclusion criteria included patients with orbital floor fractures and reconstruction using silastic sheets. Patients with orbital floor fractures and treated with other materials were excluded. The database included age, sex, cause of injury, size of floor defects, associated injury, underlying complication and period of follow-up. Results: A total of 32 patients with orbital floor fractures divided in 20 patients from Phramongkutklao Hospital and 12 patients from Songkla Hospital were included. Twenty-five patients were male (78.13%). Mean age of patients was 35.62 years (range, 15 to 62 years). Causes of injury included traffic accident (78.13%) and body assault (18.75 %). Pure orbital floor fractures were found at 31.25%. Associated injuries included fractured zygoma 43.75%, nasal bone 21.87% and fractured maxilla 12.50%. Average size of defects was 2.01 cm2. Average time to follow-up was 2.69 years. Complications were found in three cases (extrusion of silicone sheet, loss of sensation and dystopia). Extrusion was found 2 months postoperation and removal of silicone sheet was performed. Complete recovery of sensation of the infra-orbital nerve was shown at 6 months postoperation. Conclusion: No gold standard exists for implants to treat orbital floor fractures. Orbital floor reconstruction using silastic sheets involves a low complication rate and satisfactory outcome. Herein, silastic sheets can be safely used for orbital wall augmentation and provides good long term outcomes.