Preformed vs intraoperative bending of titanium mesh for orbital reconstruction.

Abstract

OBJECTIVE:

The most accurate orbital reconstructions result from an anatomic repair of the premorbid orbital architecture. Many different techniques and materials have been used; unfortunately, there is currently no optimal method. This study compares the use of preformed vs intraoperative bending of titanium mesh for orbital reconstruction in 2-wall orbital fractures.

STUDY DESIGN:

Cadaver-based study.

SETTING:

University hospital.

SUBJECTS AND METHODS:

Preinjury computed tomography scans were obtained in 15 cadaveric heads (30 orbits). Stereolithographic (STL) models were fabricated for 5 of the specimens (10 orbits). Two wall fractures (lamina papyracea and floor) were then generated in all orbits. Surgical reconstruction was performed in all orbits using 1 of 3 techniques (10 orbits each): (1) patient-specific implant molded from the preinjury STL model, (2) titanium mesh sheet bent freehand, and (3) preformed titanium mesh. Each technique was evaluated for orbital volume correction, contour accuracy, ease of use, and cost.

RESULTS:

No difference in volume restoration was found between the 3 techniques. Patient-specific implants had the greatest contour accuracy, poor ease of use, and highest cost. Freehand bending implants had the poorest contour accuracy, acceptable ease of use, and lowest cost. Preformed mesh implants had intermediate contour accuracy, excellent ease of use, and low cost.

CONCLUSION:

All 3 techniques provide equivalent orbital volume correction. However, preformed mesh implants have many advantages based on contour accuracy, ease of use, and relative cost.

• Authors: E Bradley Strong, Scott C Fuller, David F Wiley, Janina Zumbansen, M D Wilson, Marc C Metzger
• Journal: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Otolaryngol Head Neck Surg) Vol. 149 Issue 1 Pg. 60-6 (Jul 2013) ISSN: 1097-6817 [Electronic] England
• PMID: 23482478 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Titanium

Topics

• Bone Plates
• Cadaver
• Fracture Fixation, Internal (instrumentation)
• Humans
• Materials Testing
• Orbital Fractures (pathology, surgery)
• Prosthesis Design
• Plastic Surgery Procedures (instrumentation)
• Surgical Mesh
• Titanium