Using a titanium mesh plate to reconstruct the orbital floor after an incompletely reduced zygomaticomaxillary complex fracture.

Abstract

A 30 year-old male came to us for correcting his severe left enophthalmos five months after a facial trauma in a traffic accident. CT scan of his left orbit showed a greatly increased orbital volume, which was resulted from the incomplete reduction of left zygomaticomaxillary complex (ZMC) fracture, unrepaired medial and lateral walls, and improper restoration of the orbital floor with a silicone sheet. Also, the decreased ocular volume, due to the evisceration of the ruptured eyeball with intraocular silicone ball implantation, contributed to the patient's enophthalmos. Because the patient refused any kind of osteotomy for his incompletely reduced and malunion ZMC fracture in the procedures of orbital reconstruction, correction of his severe enophthalmos became very difficult if not impossible. Therefore, we used a piece of titanium mesh plate about 2.5 x 4 cm in size, and folded it into an L shape. The shorter part of the L-shaped plate was used to fix the whole plate by screwing it into the anterior surface of the inferior orbital rim. The longer part of the plate was used as a new orbital floor. To hold and push the intraocular implant upward and anteriorly, the longer part of the plate was adjusted to a level higher than the original floor level, and was bent upward gently in the posterior part. Postoperatively, the severe enophthalmos was markedly improved, and the patient was satisfied although an evident supratarsal sulcus was still present. After a follow-up of 18 months, no complication of migration, infection, or extrusion of the titanium mesh plate occurred.