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Takayuki Yamada, Hideki Mochizuki, Yoshiaki Kiuchi; Temporary Use of Silicone Plates for the Surgical Repair of Orbital Blow-out Fractures. Invest. Ophthalmol. Vis. Sci. 2011;52(14):720.
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The use of alloplastic implants for the surgical repair of blow-out fractures is controversial because of complications. The aim of this study was to assess the effectiveness of the temporary insertion of silicone plates to prevent postoperative adhesion after the repair of a blow-out fracture.
The medical records of 169 patients (125 men and 44 women with a mean age of 28.0 ± 15.4 years) with blow-out fractures, who were initially treated between April 2006 and March 2008, were reviewed. The time interval between injury and repair was 20.9 ± 77.3 days. Isolated medial wall fractures were present in 68 cases, isolated inferior fractures in 71 cases, and medial and inferior fractures in 30 cases. In all cases, surgery was performed via the transcutaneous and transorbital approach, and a silicone plate was used to replace the ruptured periorbita. All silicone plates were removed 3 months after surgery. Eye movement was assessed before and 3 months after surgery based on the percentage of Hess area ratio (HAR%) using the Hess chart; a paired t test was used to compare the differences. The significance of patient age, the interval (in days) between the time of injury and the time of surgical repair, and the fracture site as predictive factors were determined using Pearson’s correlation coefficient test and one-factor analysis of variance. A p value of <0.05 was considered significant.
Postoperative HAR% (93.5% ± 11.6%) was significantly higher than initial HAR% (68.4% ± 27.5%) (p < 0.0001; a paired t test). Older age (r = –0.49, p < 0.0001) and the interval between the time of surgery and injury (r = –0.22, p = 0.0038) were significant negative predictors of postoperative HAR%. No significant differences (p = 0.15; one-factor analysis of variance) in postoperative HAR% were observed between fracture sites: medial wall (91.3% ± 13.7%), inferior wall (95.8% ± 7.7%), and medial and inferior wall (92.6% ± 13.2%). No infection or implant extrusion associated with silicone implants was observed.
The temporary use of silicone plates for the surgical repair of blow-out fractures is an effective procedure for improving eye movement.
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