Correction of Enophthalmos by Titanium Mesh Versus Iliac Bone Graft in Case of Orbital Floor Fracture

Abstract

Background: Management of orbital fractures are one of the most interesting and difficult areas in maxillofacial surgery. Improper reconstruction of the orbit frequently results in ophthalmic complications. Keeping all these views in mind, a study had been proposed to determine the best materials in order to repair orbital floor fracture with consideration of cost, patients, benefits, time and surgical outcome. Objective: To determine the surgical outcome of orbital floor fracture reconstruction by using titanium mesh and iliac bone graft for correction of enophthalmos. Study Design: Multicenter, parallel-group, single-blind, randomized controlled trial. Study setting and period: The study was carried out in three hospitals located at Dhaka city as in the Department of Oral and Maxillofacial Surgery, Dhaka Dental College and Hospital (DDCH) Dhaka; in the Department of Oculoplasty, National Institute of Ophthalmology and Hospital (NIOH), Dhaka and Ispahani Islamia Eye Institute and Hospital (IIEIH), Dhaka. This study was conducted from 1 May, 2016 to 30 th April 2021. Method: Total 60 patients with orbital floor fractures with enophthalmos were taken for reconstruction. The patients were divided into two groups. 30 patients were taken in an intervention group where titanium mesh was used for reconstruction of orbital floor fracture. And other 30 patients were grouped into control group where iliac bone graft was used for the reconstruction of orbital floor fracture. The efficacy of titanium mesh over iliac bone graft was evaluated in terms of demographical data, facial asymmetry, enophthalmos, diplopia, ocular motility, extra ocular muscle limitation, inferior rectus muscle action, step deformity, radiological evaluation; implant migrated, bone resorption as well as post-operative complications. Results: Results of the study showed that the highest 21 – 30 years aged people (72%) usually were affected due to orbital floor fracture. More than 90% (91.67%) of orbital floor fracture patients were male. The main cause of orbital floor fracture was Road traffic accident (72%). Enophthalmos corrected 93.3% in intervention group, which was higher than control group (86.7%) at 24 th postoperative week. The mean time of correction of enophthalmos was less for intervention group (8.43 weeks) than control group (14.93 weeks); and it was statistically significant. According to Kaplan Meier Curve, between intervention and control group, enophthalmos was corrected 4 weeks earlier in intervention group. The cost-benefit analysis was conducted between the intervention group, which received titanium mesh, and the control group, which received iliac bone graft. The results showed that the intervention group had a significantly shorter recovery time of 7.45±2.30 days compared to the control group's 12.61±3.47 days (p<0.001). The operation time for the intervention group was significantly lower at 2.12±0.74 hours compared to the control group's 3.45±0.97 hours (p<0.001). Conclusion: The titanium mesh is similar and, in some cases, better than the iliac bone graft for the correction of enophthalmos in case of orbital floor fracture. It takes less operative time, less time stayed in the hospital, recovers quickly than iliac bone graft patients. Besides, unlike iliac bone graft, titanium mesh does not require a second operation. And titanium mesh is also precisely adaptable to the bone as compared to iliac bone graft. Considering all these aspects, titanium mesh is a good alternative option in comparison to iliac bone graft with more benefits for the correction of enophthalmos in orbital floor fracture.