Orbital Fracture Repair Materials: Research Hotspots, Clinical Applications, and Emerging Technologies.

Abstract

Orbital fractures, particularly of the medial and inferior walls, often require precise reconstruction to restore orbital volume and prevent enophthalmos, diplopia, and facial deformity. The selection of repair material, ranging from titanium meshes and porous polyethylene to resorbable polymers and tissue-engineered scaffolds, is therefore central to surgical success, yet a clinically oriented synthesis of the available options remains lacking. This study combines a bibliometric mapping with a focused review of repair materials to chart how the field has evolved and to clarify the relationship between material properties, fracture pattern, and treatment strategy. Literature published from 1990 to 2025 was retrieved from the Web of Science Core Collection and analyzed using VOSviewer, CiteSpace, and the R package "bibliometrix"; 1156 articles were included. The USA contributed the largest number of publications (272), followed by South Korea (124) and China (118), with the University of Helsinki (58 articles) and the Journal of Craniofacial Surgery (H-index 32) being the most productive institution and journal, respectively. Six thematic clusters were identified: biomaterial types, outcome prediction, complications, absorbable polymers, allografts, and surgical approaches. Keyword burst analysis highlighted emerging interests in "floor" (2021-2025) and "intraoperative navigation" (2022-2025). We further map these clusters onto concrete clinical scenarios: small orbital floor defects may be managed with resorbable polymers, whereas extensive, comminuted fractures or cases with severe enophthalmos require the rigid support of titanium or patient-specific implants (PSI). The field is progressing from conventional fixation toward computer-assisted planning, PSI, and bioactive tissue-engineered constructs. Future efforts should prioritize validating navigation-guided implantation for orbital floor reconstruction while advancing novel biomaterials that promote osteogenesis and minimize complications.