Reduction of Trapdoor Type Orbital Floor Fracture with Absorbable Mesh

Hwang, Weon Jung

Abstract

The orbital floor fracture of trapdoor subtype is a pure orbital fracture, linear in form and hinged medially, which allows herniation of orbital fat and ocular muscles and then entraps these contents. The goals of the reconstruction of the orbital fracture are to restore the continuity and to avoid a relapse the orbital tissue. If the reconstruction is incomplete, it may result in enophthalmos with diplopia. The indications for surgical reconstruction are the imitation of ocular muscles, the persisting diplopia, enophthalmos, large size of bony defect. There are no uniformly guidelines for the materials for orbital reconstruction. The ideal material should be biocompatible, non-carcinogenic, easily kept in position and free of any potential for disease transmission. Among the materials, the absorbable mesh is used for the orbital reconstruction recently. We used the 0.8mm thickness absorbable mesh in 11 patients with orbital floor trapdoor fracture. The displaced bony fragment was reducted and the absorbable mesh was inserted below the reducted fragment. The absorbable mesh was fixated with absorbable screw, so the mesh can support the bony fragment with cantilever effect. The results were satisfactory and no significant problem was not happened during the follow up period. Absorbable meshes are gradually resorbed and the scar that formed after resorption provides the support of the globe. Our results suggest that the orbital floor trapdoor fracture with small to moderate defects is the advisable indication of orbital reconstruction with absorbable mesh.