Reconstruction of the bony orbit in patients with combined midface injuries is a frequently discussed topic in the current literature. Two main concepts can be distinguished: single-stage reconstruction, usually with a hand-bent titanium orbital mesh, or two-stage reconstruction, in which osteosynthesis of the ZMC is followed by orbital reconstruction with a virtually planned patient-specific titanium implant in a second surgery. This study aims to compare one- and two-stage surgical approaches on combined midface fractures regarding postoperative diplopia.
58 patients treated with either a one-stage (29) or a two-stage (29) reconstruction of the ZMC and the orbit were included in this study and their postoperative course over five months was retrospectively analyzed.
A descriptive quantitative analysis recording the course of occurence of diplopia was recorded to calculate the success of orbital repair in complex midface fractures including the orbit. The two presented workflows differed in the prevalence of postoperative clinical diplopia and eyelid complications.
There are multiple factors affecting the decision whether or not to reconstruct the orbit firsthand and in the same intervention as the associated midface fracture. Thorough evaluation of each individual patient and patient-specific choice of surgical concept are crucial and include multiple factors.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to British Journal of Oral and Maxillofacial Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Status of the internal orbit after reduction of zygomaticomaxillary complex fractures.J Oral Maxillofac Surg. 2004; 62: 275-283
- Criteria for selective management of the orbital rim and floor in zygomatic complex and midface fractures.Archives of otolaryngology–head & neck surgery. 1997; 123: 378-384
- Clinical recommendations for repair of orbital facial fractures.Curr Opin Ophthalmol. 2003 Apr; 14: 236-240
Essig H, Dressel L, Rana M, et al. Precision of posttraumatic primary orbital reconstruction using individually bent titanium mesh with and without navigation: a retrospective study. Head Face Med 2013 Feb;9(1).
- Surgical Outcomes of Orbital Fracture Reconstruction Using Patient-Specific Implants.J Oral Maxillofac Surg. 2021 Apr; 79: 1302-1312
- Orbital Reconstruction: Patient-Specific Orbital Floor Reconstruction Using a Mirroring Technique and a Customized Titanium Mesh.J Craniofac Surg. 2016; 27: 1822-1825
- A prospective multicenter study to compare the precision of posttraumatic internal orbital reconstruction with standard preformed and individualized orbital implants.J Craniomaxillofac Surg. 2016; 44: 1485-1497
- Management of orbital fractures: challenges and solutions.Clin Ophthalmol. 2015 Feb; 9: 2127-2137
- Associated Ophthalmic Injuries in Patients With Fractures of the Midface.Craniomaxillofac Trauma Reconstr. 2020 Feb; 13: 168-173
- Secondary Corrections of the Orbit: Solitary Fractures.Atlas Oral Maxillofac Surg Clin North Am. 2021 Apr; 29: 129-137
- Factors Influencing Postsurgical Diplopia in Orbital Floor Fractures and Prevalence of Other Complications in a Series of Cases.J Oral Maxillofac Surg. 2018 Feb; 76: 1725-1733
- Evidence-based medicine: Orbital floor fractures.Plast Reconstr Surg. 2014; 134: 1345e-e1355
- Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity.Plast Reconstr Surg. 2002 Feb; 110: 1417-1429
- Patient specific implants (PSI) in reconstruction of orbital floor and wall fractures.J Craniomaxillofac Surg. 2015 Feb; 43: 126-130
- Computer-Assisted Secondary Orbital Reconstruction.Craniomaxillofac Trauma Reconstr. 2021 Feb; 14: 29-35
Accepted: March 8, 2023
Received in revised form: March 1, 2023
Received: October 18, 2022
Publication stageIn Press Accepted Manuscript
© 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.