Background: The purpose of this study was to objectively assess the accuracy of orbital reconstruction in patients with medial wall fractures following placement of computer-designed, prebent anatomical mesh plates by means of a transconjunctival-retrocaruncular approach.
Methods: This was a retrospective, cohort study of consecutive subjects with facial trauma who underwent reconstruction of medial wall/orbital floor defects over a 12-month period at a level I trauma center. All subjects had preoperative and postoperative computed tomographic scans with 1.25-mm slices formatted in the axial, coronal, and sagittal planes with a minimum of 3 months' follow-up. Preoperative and postoperative orbital volumes were computed using integrated analysis over the orbital slices. The volumes were compared using nonparametric paired samples comparisons (Wilcoxon signed ranks test). For all analyses, p ≤ 0.05 was considered significant.
Results: Fifteen subjects underwent repair of 17 medial wall fractures. The mean patient age was 37 ± 16 years (range, 18 to 59 years); one subject was female. Motor vehicle-related incidents and assaults were the most common mechanisms of injury. The average postoperative volume for the fractured sides was 22. 2 ± 2.1 cm3 (range, 19.9 to 26.9 cm3) and was statistically significantly lower than the preoperative volume on the fractured side (24.18 ± 2.57 cm3; p < 0.001). One patient (6.7 percent) experienced a postoperative complication requiring reoperation.
Conclusion: Computer-designed, prebent anatomical mesh plates placed using a transconjunctival-retrocaruncular approach for reconstruction of medial wall fractures with orbital floor components reliably results in restoration of contour and volume, with a low complication rate.
Clinical question/level of evidence: Therapeutic, IV.