title: Low-profile titanium mesh in the use of orbital reconstruction: A pilot study.
abstract: OBJECTIVE
  The purpose of this study was to share our clinical experience in the use and accuracy of a newly designed, low-profile titanium mesh (Modus OPS 1.5; Medartis, Basel, Switzerland) for primary internal orbital reconstruction.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  This study was conducted at the Department of Cranio-Maxillofacial Surgery at the University Hospital of Bern, Switzerland, starting November 2008. Patients were included who had a defect size of ≥2 cm(2)  or fractures of more than one wall. The operations were performed within 14 days after trauma. To repair the orbital fracture, a newly designed titanium mesh was applied. The technical innovation in regard to these plates is the low-profile height of 0.25 mm along the border and 0.2 mm in the mesh area. Two different sizes of two different types of mesh are available for reconstruction. Preoperative computed tomography (CT) scans were obtained to assess the fracture size and location. A maxillofacial surgeon performed pre- and postoperative assessments (at 2 weeks, 12 weeks, and 6 months). Ophthalmologic assessments were performed preoperatively and 6 months after the operation. Postoperative CT scans were obtained within 12 weeks after the operation and the orbital volumes analyzed by a radiologist.
  
  
  RESULTS
  Twenty-seven patients underwent surgery (11 female; average age, 55.2 years). Final postoperative ophthalmologic follow-up was obtained at a mean of 8.8 months (range, 4.0-20.1 months). Twenty-five patients (93%) had a successful treatment outcome without complications. In two patients, the plate was buckled in the posterior edge region and had to be replaced. Surgical revision was performed within 3 weeks after the first procedure. These patients showed good clinical and radiologic outcome after the second procedure. At the final assessment, none of the patients had experienced diplopia. Three patients showed slight enophthalmos (2-mm side difference), however, without any subjective functional or aesthetic concerns. According to the literature, an average orbital volume difference of up to 1.95 cm(3)  is normal. In our study, radiologic volume assessment showed a side difference of ≥2 cm(3)  in four patients, of which one patient presented with a clinically detectable enophthalmos.
  
  
  CONCLUSIONS
  The newly designed, thin titanium mesh is a reliable and safe implant for the repair of orbital defects. Owing to insufficient intraoperative control, two plates showed buckling at the posterior border, which made a repair necessary. Awareness of this problem may avoid such complications in the future. However, it would seem reasonable to improve the stability of the mesh by increasing the profile height, to minimize potential complications.
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Hospital Luzern, Luzern, Switzerland. olivier.lieger@ksl.ch
authors.forename: Olivier
authors.initials: O
authors.lastname: Lieger
authors.forename: Benoit
authors.initials: B
authors.lastname: Schaller
authors.forename: Frauke
authors.initials: F
authors.lastname: Kellner
authors.forename: Brigitte
authors.initials: B
authors.lastname: Messmer-Schai
authors.forename: Tateyuki
authors.initials: T
authors.lastname: Iizuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D010865:Pilot Projects; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013526:Surgical Mesh; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014025:Titanium