Treatment of
blow-out fractures is aimed at the prevention of permanent
diplopia and cosmetically unacceptable
enophthalmos. Porous
polyethylene sheets are one of the most common alloplastic implants for
blow-out fracture repair. Because adhesion between the porous
polyethylene and the orbital soft tissue can result in restrictions of ocular motility, prevention of postoperative adhesion is important in the reconstruction of
blow-out fractures. The purpose of this study was to find out the effect of the mixed
solution of
sodium hyaluronate and
sodium carboxymethylcellulose (HACMC) on postoperative adhesion in
blow-out fracture repair in an animal model.Twenty-four New Zealand white rabbits were used. An 8-mm defect was made in the maxillary sinuses including the bone and mucosa. A 10-mm porous
polyethylene sheet (
Medpor; Porex Surgical Inc., Newnan, GA) was inserted in to the defect. The rabbits were divided into a control group and a HACMC group. In the HACMC group, HACMC
solution was instilled onto the surface of the implant and then the implant was inserted. The implants were harvested at 1, 2, 4, and 8 weeks after surgery (3 implants each period).
Hematoxylin and
eosin, Masson trichrome, and CD31 (
platelet endothelial cell adhesion molecule-1) stains were performed for evaluation of
inflammation,
fibrosis, and vascularization.Inflammation appeared less severe in the HACMC group, but the difference between the 2 groups was not statistically significant. The degree of
fibrosis was more severe in the control group. There were significant differences in the degree of
fibrosis between the 2 groups 4 and 8 weeks after surgery (P = 0.046). The amount of vascularization was similar in both groups.The HACMC
solution seemed to be effective for reducing postoperative adhesion in reconstruction of
blow-out fractures in a rabbit model. Our results suggest that the application of HACMC
solution could be an effective adjunct for the repair of trap-door fractures or revision of
blow-out fractures.