During the past several decades, the standard of care for orbital reconstruction after
trauma has been autogenous bone grafts. Complications of bone grafts, including donor site morbidities such as
scar alopecia and graft resorption with delayed
enophthalmos, have inspired an interest in the use of alloplastic substitutes such as
titanium.
Titanium's role in orbital reconstruction was limited originally to small orbital defects, and as an adjunct to bone grafts. More recently, clinical studies have documented the sole use of
titanium mesh to reconstruct large orbital defects. This study sought to document further the safety and efficacy of
titanium mesh in reconstructing large orbital defects after facial
trauma, with more extensive follow-up compared with previous studies. In the current study, 55 patients with 67
orbital fractures underwent orbital reconstruction with
titanium mesh over a 5-year period. Associated fractures were reduced anatomically and fixed rigidly. For the analysis, 44 patients with 56
orbital fractures had adequate follow-up (mean, 44 months). An
abscess developed in one patient who received high-dose
steroids for 72 hours before reconstruction. She was treated with broad-spectrum intravenous
antibiotics and bedside incision and drainage, and did not require removal of the
titanium mesh. No patient in the current series required removal of the
titanium mesh. A single case of uncorrected
enophthalmos was treated with
bone grafting rather than mesh revision. Large orbital defects can be reconstructed using
titanium mesh with good functional results and minimal risk for
infection. This study covered the authors' first 5 years using
titanium. They have now used
titanium mesh in orbital reconstructions for more than 10 years, without any additional cases of
infection.