Reconstruction of orbital floor with ethisorb /certified fixed orthodontic courses by Indian dental academy

Reconstruction 0f Orbital Floor #
with Polyglactin
910/Polydioxanon patch
(ETHISORB)
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


PURPOSE
• To evaluate the effectiveness and the
complications related to the use of Ethisorb
(resorbable alloplastic material) in the
reconstruction of Orbital floor #’s.


INTRODUCTION
Orbital floor #’s can be broadly classified as pure
blow out #’s or Impure blow out #’s.
If improperly treated, these #’s may lead to
serious complications usually Diplopia,
Enophthalmus and reduced globe mobility.
Goals of treatment is to free the prolapsed orbital
tissue from the # defect and to span the defect
with an implant to restore the correct anatomy of
the orbital floor and pre trauma orbital volume.

CHOICE OF IMPLANT FOR ORBITAL
FLOOR RECONTRUCTION
• AUTOLOGOUS MATERIALS: Periosteum, Naso
septal cartilage, Rib graft, Mandibular bone,Cranial
bone graft Etc…
• ALLOGENIC MATERIALS: Lyophilized dura,
Lyophilized cartilage.
• ALLOPLASTIC MATERIALS:
-Resorbable: Poly-L-Lactide, Polydioxanon (PDS),
Vicryl mesh( polyglactin-910),Polyglycolic acid
-Non Resorbable:Silicone,Teflon,Medpor,Titanium
mesh.

ETHISORB
• It’s a synthetic resorbable patch/mesh consisting
of a semiflexible membrane of 0.6 x 20 x30 mm.
• It’s composed of nondyed Vicryl polyglactin 910
and nondyed PDS.
• This material completely resorbs after 3
months.During resorption its replaced by fibrous
collagenous tissue with minimal inflammation.
• It acts as a scaffold establishing a supporting
structure on which the peri orbita will heal.
• Also finds its use in bridging dura mater defects.

PATIENTS & METHODS
• Orbital floor was explored in all patients with
Enophthalmos, Restricted globe motility,Diplopia or
large floor defect as visualised on CT.
• Exploration was carried in all cases through a trans
conjunctival approach without lateral
canthotomy,subperiosteal dissection was done to
expose the defect and to free the prolapsed soft
tissue.
• Care was taken to protect Infra orbital
nerve.Dislocated bone fragments were reduced if
possible and defect exposed circumferentially.Stable
bone was found all around the defect.

• In large floor #’s a posterior stable ledge of bone
was sometimes difficult to identify,so ETHISORB
was fashioned, trimmed with scissors and placed
to bridge the floor defect.
• In every case the Implant covered the whole defect
and that it rested posterior to Infra orbital rim.
• None of Implants were fixed.
• In case of defects larger than Ethisorb
membrane,Lyophilised cartilage was used.These
Pts were not included for this study.
• Forced Duction test was performed before wound
closure to ensure normal motility.

RESULTS
• Totally 87 Pts were treated for Orbital floor
reconstruction using ETHISORB.
• Cause for #’s ranged from RTA to altercations.
• Time from trauma to surgery ranged from 7 hrs to
37 days.
• Pre operatively: 26 Pts with Diplopia,
2 Pts with Enophthalmos, 34 Pts with Infra orbital
nerve hyposthesia.74 Pts were investigated
preoperatively by coronal and axial CT.
• 28 Pts with Pure Blow out # and 59 Pts with
Impure Blow out #( along with orbito-zygomatic #
that needed exposure and fixation of the Infra
orbital rim).

• Post operatively :
-66 Pts had no complication
-5 Pts had Diplopia in extreme gauze
-3 Pts had mild ectropions
-7 Pts Infra Orbital nerve hypesthesia
-3 Pts had Epiphora
-2 Pts had Symblepharon
-1 Pts had lower lid edema, which improved
with massage therapy

DISCUSSION
• The most important component of Orbital floor
reconstruction is the restoration of the pre trauma
volume of the internal orbit.
• Advantages of resorbable alloplastic materials
include:
-unlimited availability of the material
-decreased operative time
-no donor site morbidity and complication
-no risk of infectious disease transmission
-avoidance of late complications associated with
non resorbable alloplastic materials like
infection, migration, extrusion.

• ETHISORB should be used only is small to moderate
orbital floor #,one must make sure that mesh spans the
entire defect and also rests on a stable bone all round the
defect.If the mesh rests properly on a stable bone the risk
of developing Enophthalmos post operatively after the
resorption of the implant is negligible, because the
reconstructed scar is stiff enough to support the globe.
This can be confirmed by CT.
• Use of more than one ETHISORB is not recommended,if
the defect is larger than the mesh another type of implant
should be used (ie lyophilised cartilage)

CONCLUSION
• This study demonstrates the effectiveness of
ETHISORB in the repair of small to
moderate orbital floor # defects( upto a
maximum size of 2 x 2 cm).


THANK YOU


Reconstruction of orbital floor with ethisorb /certified fixed orthodontic courses by Indian dental academy

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Reconstruction of orbital floor with ethisorb /certified fixed orthodontic courses by Indian dental academy