OBJECTIVE: The orbital floor is frequently involved in head trauma. Current evidence on the use of reconstruction materials for orbital floor repair is inconclusive. Accordingly, this study aimed to compare the impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures.
METHODS: Standardized isolated orbital floor fractures were symmetrically created in 11 cadaver heads that provided 22 orbits. PDS foils with thicknesses of 0.25-0.5 mm were inserted. Computed tomography (CT) scans of the native, fractured, and reconstructed orbits were obtained, and orbital volume, orbital height, and foil bending were measured.
RESULTS: Orbital volume and height significantly (p < 0.01) increased after the creation of isolated orbital floor fractures and significantly (p = 0.001) decreased with overcorrection of the orbital geometry after orbital floor reconstruction with PDS 0.25 mm or PDS 0.5 mm. The orbital geometry reconstruction rate did not differ significantly with respect to foil thickness. However, compared to PDS 0.5 mm, the use of PDS 0.25 mm resulted in quantitatively higher reconstructive accuracy and a restored orbital volume that did not significantly differ from the initial volume.
CONCLUSIONS: Orbital floors subjected to isolated fractures were successfully reconstructed using PDS regardless of foil thickness, with overcorrection of the orbital geometry. Due to its lower flexural stiffness, PDS 0.25 mm appeared to provide more accurate orbital geometry reconstruction than PDS 0.5 mm, although no significant difference in reconstructive accuracy between PDS 0.25 mm and PDS 0.5 mm was observed in this cadaveric study.

BACKGROUND: Current indications of maxillary reconstruction with scapular tip free flap (STFF) are palatoalveolar defects associated with zygomaticomaxillary buttress and/or orbital floor defects. STFF can be placed either horizontally or vertically. Horizontal placement usually allows ideal palatal conformation, preventing oronasal communication, but has been argued to compromise orbital support and projection of the midface, whereas vertical placement is advocated for midface support but may be insufficient for the complete closure of the palate. The present study focuses on the horizontal placing of STFF to allow complete palate reconstruction and fistulae prevention while still obtaining optimal midface projection and orbital support.
METHODS: This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed.
RESULTS: None of the patients presented palatal fistulas or alterations in the orbital support.
CONCLUSIONS: A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support.

BACKGROUND: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy.
OBJECTIVE: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers (\"In-House\" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh.
METHODS: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data.
RESULTS: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the \"Magna Graecia\" University Hospital of Catanzaro 10 fulfilled the study\'s inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment.
CONCLUSIONS: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient\'s anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

UNASSIGNED: Intraosseous hemangiomas are rare benign tumors comprising fewer than 1% of all osseous tumors; even more uncommon are intraosseous hemangiomas of the zygomatic bone. This case reports a multidisciplinary approach for excision and reconstruction of an intraosseous hemangioma of the zygomatic bone in a 54-year-old female.
UNASSIGNED: Multidisciplinary approach with both otolaryngology head and neck surgery and oculofacial plastics and reconstructive surgery included right lateral canthotomy and right transconjunctival orbitotomy with en-bloc excision of the zygomatic arch, followed by reconstruction of the orbital rim, orbital floor, and eyelid with Medpor implant.
UNASSIGNED: Final surgical pathology was consistent with intraosseous hemangioma of the zygomatic bone. At 4-month follow-up, the patient was healing well with good midface projection and without any visual deficits.
UNASSIGNED: A multidisciplinary coordinated case allowed us to meet the standard of maintaining cosmesis and function while undergoing resection of a rare tumor involving a key facial structure-the zygoma. Involvement of oculofacial plastics and reconstructive surgery service allowed for advanced eyelid reconstruction techniques to limit any functional impairment to our patient with deliberate choice of implant material for well-adhered, durable, and aesthetically optimal reconstruction of the right malar eminence, lateral orbital rim, and orbital floor defect. The postoperative result through the multidisciplinary approach was a near symmetrical facial reconstruction without any associated eyelid or globe abnormalities.

UNASSIGNED: Foreign body reaction to non-absorbable alloplastic orbital implants utilized for bony reconstruction are infrequently documented in the literature. We present the workup and surgical management of a giant cystic mass encapsulating a patient\'s alloplastic orbital implant, which was ultimately deemed to be a result of foreign body reaction.
UNASSIGNED: A 41-year-old male patient with distant history of a right orbital floor fracture had undergone repair with the placement of a nylon foil implant. The patient presented twenty years later with progressive ipsilateral globe proptosis and was found to have a giant inferior orbital cyst. Surgical exploration and removal of the implant and capsule were performed. Histopathology confirmed a delayed foreign body reaction around the patient\'s alloplastic implant.
UNASSIGNED: Alloplastic implants may result foreign body reaction and cyst encapsulation as a delayed complication.

Silent sinus syndrome (SSS) is a relatively rare clinical condition occurring in the maxillary sinus exhibiting progressive enophthalmos and hypoglobus. The communication between the orbit and maxillary antrum due to trauma further leads to changes in the maxillary sinus. This could lead to the development of negative pressure within the maxillary sinus, collapse of antrum walls, and sucking in of orbital contents. Here, we present a case of a delayed orbital trauma, which was not treated initially. The patient\'s complaint was a constant feeling of a sunken right eye along with restriction in eye movements. On examination, the clinical and radiographic features were consistent with SSS. Orbital floor reconstruction was performed with the help of a titanium mesh for the correction of hypoglobus and enophthalmos. During follow-up, the patient showed no recurrence of the presenting functional and esthetic complaints. This clinical entity needs prompt diagnosis and early intervention so as to prevent further complications.

OBJECTIVE: The aim of this study was to analyse the outcomes of orbital floor reconstruction with two types of orbital implants and assess patients\' quality of life.
METHODS: 39 sequential patients with clinical and radiological evidence of orbital floor fracture, presenting diplopia, enophthalmos, paraesthesia or a post traumatic residual orbital deformity were included in this study and randomised for orbital floor reconstruction using porous polyethylene sheet (Biopore™) or preshaped titanium mesh on a 3D model. Their pre and postoperative quality of life were compared. Success rate was assessed and scored with a minimum of zero (none) and a maximum of ten (excellent) for improvement in the signs of diplopia, enophthalmos, hypoglobus, paraesthesia and aesthetics.
RESULTS: Both QOL scores and Success score was greater in cases which reconstruction of orbital floor was performed with preshaped titanium mesh as compared to those with Biopore™.
CONCLUSIONS: Preshaped titanium mesh shows better results than reconstruction with Biopore™. However a large sample size and a long term follow up is needed for generating the best evidence. Quality of life extensively improves after orbital floor reconstruction motivating the patients desire to live.

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UNASSIGNED: To assess the feasibility and the outcome of endoscopically assisted repair of zygomatico-maxillary complex orbital fractures in a tertiary care hospital.
UNASSIGNED: A descriptive study was carried out over a period of 2 years (01. 11. 2014-31. 10. 2016). 0°-4 mm endoscopes were used for intra-operative endoscopic exploration. Regular armamentarium for management of maxillofacial trauma along with standard plating systems was used. Commercially available medical grade titanium meshes were utilised for orbital floor reconstruction.
UNASSIGNED: Fifty-seven of hundred and twelve surgically managed zygomatico-maxillary complex fractures required orbital exploration. Twenty-one of these had reconstruction of the orbital floor. Endoscopically assisted exploration was performed in 10 of the 21; trans-nasally in three cases, the Caldwell-Luc approach was used in three cases, and in another three, the existing fracture in the anterior wall of the maxilla was utilised. In addition, an endoscopic trans-nasal-sphenoidal approach was opted for to access the orbital apex to manage fractured bone fragments that were impinging on the optic nerve in one of the patients.
UNASSIGNED: Endoscopes serve as the primary tool in minimally invasive procedures. They are yet to evolve as a major role player in the maxillofacial arena. The authors conclude that endoscopes are truly beneficial as an adjunct to existing techniques. They hold much promise for the future.

In this prospective study we evaluated the duration of insertion and the accuracy of fitting of computer-aided design (CAD)-based pre-bent orbital floor plates compared with non-preformed orbital plates in reconstruction of the orbital floor. Thirty-six patients with unilateral fractures of the orbital floor were included; pre-bent plates were used in 25 and non-preformed plates in 11. Preoperative computed tomography (CT) scans were used for CAD of individualised implants. The anatomy of the affected orbit was virtually reconstructed \"slice by slice\". Individually pre-bent plates were generated using a stereolithographic model of the reconstructed orbit. The mean (SD) duration of insertion was significantly reduced when pre-bent orbital plates were used (5.5 (5.4) min) compared with non-preformed meshes (11.1 (7.7) min). The congruence of pre-bent plates to the infraorbital rim did not differ from that of non-preformed plates. The accuracy of fit was rated as \"accurate\" in 24 cases. CAD-based individualised titanium meshes reduce theatre time compared with non-preformed orbital plates. Our results confirm the efficacy of CAD-based pre-bent plates in reconstruction of the orbital floor.