title: Orbital floor fractures--short- and intermediate-term complications depending on treatment procedures.
abstract: BACKGROUND
  Many reconstruction materials for orbital floor fractures have been described in the past including autologous bone transplants, resorbable polymers and titan meshes. So far evidence is missing which material is used successfully regarding indication and particular size of defect. Therefore the aim of this study was to evaluate which reconstruction technique produces best clinical outcome and least complications associated with indication.
  
  
  METHODS
  Retrospectively, surgical and ophthalmological data plus CT scans from a collective of 775 patients between 2005 and 2012 were analyzed. Furthermore included patients were sounded on satisfaction and potential problems postoperatively.
  
  
  RESULTS
  Overall 593 patients offered full pre- and postoperative short-time data appropriate to inclusion criteria - of these 507 (85,5 %) underwent primary surgical treatment. Smallest average defect size was found in cases with no indication for surgical treatment (81 mm(2)), largest in cases indicating titanium mesh reconstruction (601.5 mm(2)). In 15 cases exact fragment reposition was possible without insertion of alloplastic material. Best clinical results obtained reconstruction using polydioxanone foil (PDS). 0.15 mm PDS-foil: 444 patients, reduced diplopia pre to postoperative 16 to 6 % (p < 0.01), ex- and enophthalmus < 2 % after surgery. 0.25 mm PDS-foil: 26 patients, reduced diplopia from pre- to postoperative 34,6 to 3,8 % (p < 0.01), postoperative exophthalmus rate was higher than preoperative (3,8 to 7,7 %). In comparison to reconstruction with PDS-foil a higher percentage of patients reconstructed with titanium meshes (n = 22) revealed no significant reduction of diplopia (45,5 to 31,8 %; p = 0.07). Furthermore 63 of all included patients agreed to complete a questionnaire on intermediate-term postoperative symptoms and surgical contentedness. Remarkably 50 % of the patients reconstructed with titanium meshes indicated foreign body sensations and cold feeling in the long-term.
  
  
  CONCLUSIONS
  Short- and intermediate-term results of clinical outcome in our patients with surgical treated orbital floor fractures (i.e. diplopia, en- or exophthalmus) reveal that thin resorbable foils, particularly 0.15 mm diameter PDS-foil seem to generate best results referring to orbital floor defects with a size of 250 to 300 mm(2).
  
  
  BACKGROUND
  Study number 4222, year 2013, ethics committee of the medical faculty of the Heinrich Heine university of Duesseldorf.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Plastic Surgery of the Face, University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Duesseldorf, Germany. Henrik.Holtmann@med.uni-duesseldorf.de.
authors.forename: Henrik
authors.initials: H
authors.lastname: Holtmann
authors.affiliation: Department for Oral Surgery, University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Duesseldorf, Germany. Hatice.Eren@med.uni-duesseldorf.de.
authors.forename: Hatice
authors.initials: H
authors.lastname: Eren
authors.affiliation: Department of Oral and Maxillofacial Surgery, Plastic Surgery of the Face, University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Duesseldorf, Germany. Karoline.Sander@med.uni-duesseldorf.de.
authors.forename: Karoline
authors.initials: K
authors.lastname: Sander
authors.affiliation: Department of Oral and Maxillofacial Surgery, Plastic Surgery of the Face, University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Duesseldorf, Germany. kuebler@med.uni-duesseldorf.de.
authors.forename: Norbert R
authors.initials: NR
authors.lastname: Kübler
authors.affiliation: Department of Oral and Maxillofacial Surgery, Plastic Surgery of the Face, University Hospital of Duesseldorf, Moorenstr. 5, D-40225, Duesseldorf, Germany. handschel@uni-duesseldorf.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Handschel
mesh_terms: D000328:Adult; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome