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T. Dahl, Jr., D. Holck, J. Foster, J. Ng; Colmplication Rate of Internal Orbital Wall Fracture Repair Using Porous Polyethylene/ Titanium Mesh (MEDPOR TITANTM) Implants . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3791.
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Recently, a porous polyethylene sheet with titanium mesh has been available for use in non–weight bearing applications as seen with internal orbital fractures (TITAN implants, MEDPOR Surgical, Newnan, GA, USA). We evaluated the utility of this material in large floor and combined floor/ medial wall fractures.
Fourteen patients with extensive orbital floor (8 patients) fractures and combined orbital floor and medial wall (6 patients) fractures underwent surgical repair between 9/04 and 4/05. Each patient had the orbital fracture reduced using the TITAN orbital implant. The patients were followed postoperatively for a minimum of six months, checking ocular position and function, and implant position was checked with computed tomography.
Intraoperatively, the porous polyethylene covering of the titanium mesh allowed smoother edges of the titanium mesh after cutting facilitating implant placement. Additionally, the implant was bent to conform to the contours of the intact bony ledges surrounding the fracture site. The titanium mesh minimized the memory of the bent implant, facilitating placement. Postoperatively, none of the implants required removal or repositioning. Postoperative computed tomography verified implant placement in all cases. In one patient, verification of correct implant position was useful to avoid a return to the operating room in a patient with unimproved postoperative dysmotility. In this case, the lack of improvement was related to inferior rectus trauma (and hematoma), and slowly improved over six months. In one patient, 1.0mm of hyperglobus was noted postoperatively, which was not concerning to the patient, and she refused additional surgery. This patient received a 1.5mm thick implant.
The increased strength of the implant from the titanium mesh allows a thinner implant that avoids the abaxial displacement that may be seen with thicker implants. The lack of memory and immobilization of the implant using screw or suture fixation allows greater implant stability. Additionally, the titanium mesh allows postoperative imaging to verify implant placement, which may be critical in those situations where adequate postoperative soft tissue release needs to be demonstrated. The TITAN orbital implant sheets provide a distinct advantage in large single wall fractures, multiple internal wall fractures (orbital floor and medial wall) or those floor fractures with inadequate posterior support requiring an implant with greater strength.
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