Re: “Secondary Orbital Reconstruction in Patients With Prior Orbital Fracture Repair”

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We read with interest Kim et al.’s article1 on secondary orbital reconstruction in 13 patients with prior orbital fracture repair using medpor titanium sheet and nylon foil. Time interval between the trauma and secondary reconstruction was 3 days to 11.7 years.1 Although they have reported a good postoperative satisfaction in almost all the patients with a statistically significant reduction of enophthalmos and hypoglobus,1 a couple of considerations should be taken into account in the surgical management of patients with postorbital fracture globe displacement (enophthalmos and hypoglobus).
There are 2 mechanisms for globe displacement based on the time interval after the trauma. Early globe displacement (within 2 months) is due to dislocation of orbital walls (mainly medial and floor). Whereas, gradual fibrosis and contraction of the orbital contents, as well as orbital fat atrophy are the other additive factors which cause more globe displacement in time.2–4 The longer the time interval between the trauma and final reconstruction, the more fibrosis and volume loss is observed. While any degree of early globe displacement can be corrected with proper relocation of the orbital walls with different sheets, foils, and meshes, late repair of orbital fractures ends with less satisfactory enophthalmos correction because of volume changes in the orbit that has begun soon after the trauma and progressed over several months and years.3–6 Therefore, reconstruction of the orbital wall fracture should be augmented with volume replacing implants like Medpor enophthalmos wedge or silicone block.3
While a meticulous incision and dissection, complete repositioning of prolapsed and incarcerated orbital tissue, and exposing borders of the fracture site are essential to the final success of primary orbital reconstruction, adding an appropriate size and shape of the implant (based on the CT imaging and degree of globe displacement) are crucial to the final correction of enophthalmos and hypoglobus during the secondary orbital reconstruction.
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