Advances in biotechnology continue to introduce new materials for reconstruction of orbital floor fractures. Which material is best fit for orbital floor reconstruction has been a controversial topic. Individual surgeon preferences have been supported by inconsistent inconclusive data. The purpose of this study was to assess and analyze published evidence supporting various materials used for orbital floor reconstruction and to develop a decision-making algorithm for clinical application. A systematic literature review was performed from which 48 studies were selected after primary and secondary screening based on set inclusion and exclusion criteria. This cumulatively included 3475 separate orbital floor reconstructions. Results revealed risk and benefit profiles for all materials. Autologous calvarial bone grafts, porous polyethylene, and polydioxanone (PDS) were most widely used for orbital floor reconstruction. Increased infection rates were reported with polyglactin 910/PDS composites and silastic rubber. Ocular motility was reduced most with lyophilized dura and PDS. Preoperative and postoperative rates for diplopia and enophthalmos varied among the materials. In conclusion, our results revealed continued inadequate evidence to exclusively support the use of any one biomaterial/implant for orbital floor reconstruction. Results have served to create a decision-making algorithm for clinical application. Our authors propose certain parameters for future studies seeking to demonstrate a comparison between 2 or more materials for orbital floor reconstruction.
From the *Miller School of Medicine, and †Division of Plastic and Reconstructive Surgery, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.
Received April 14, 2012.
Accepted for publication April 16, 2012.
Address correspondence and reprint requests to Seth R. Thaller, MD, DMD, FACS, Division of Plastic and Reconstructive Surgery, The DeWitt Daughtry Family Department of Surgery, University of Miami Health System, Clinical Research Building, 1120 NW 14th St, 4th Floor, Miami, FL 33136; E-mail: SThaller@med.miami.edu
The authors report no conflicts of interest.