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Ryan T. Scruggs, Rodgers L. Eckhart, Steven A. Newman; Absorbable Material for Floor Repair in the Setting of Wide Eyed Blowout Fractures. Invest. Ophthalmol. Vis. Sci. 2011;52(14):716.
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True entrapment of the inferior rectus muscle is an uncommon finding usually in young patients following orbital floor fracture. Rapid intervention is often necessary to prevent permanent ischemic damage to the inferior rectus muscle resulting in persistent motility disturbance. Traditionally, multiple alloplastic material including med pore, titanium, and silicone have been used to reconstruct the floor. Absorbable material (Gelfilm) has been utilized in the past.
A retrospective review of 4 patients undergoing immediate intervention for entrapment following orbital fracture and repaired with the placement of gelfilm are presented. All were approached with a trans-conjunctival incision without release of the lateral canthal tendon. Patients included 3 males and 1 female aged between 8 and 12. All 4 patients were treated within 24 hours with removal of surrounding bone, replacement of soft tissue within the orbit, and placement of Gelfilm. Quantitative assessment included Hertel measurements, palpebral fissure measurements, and the use of the Hess screen to document relative motility.
One patient had transient swelling of the lower lid, presumably infectious, treated with antibiotics. No other complications ensued. Long term follow up showed complete resolution of ocular motility problems with normal stereopsis and no evidence of significant enophthalmos.
Absorbable Gelfilm is a reasonable alternative in repair of blowout fractures with a high degree of success in a limited case series. Quantitative motility assessment with Hess screen confirms improvement in ocular motility.
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