Orbital Floor Blowout Fracture Reconstruction Using Moldable Polymethyl Methacrylate: A Report of Two Cases and Their Imaging Findings

Abstract

Majed Fehaid AlSubaie,1,2 Abdulaziz Mohammad Al-Sharydah,3 Hala M Nassim,1 Abrar Hawsawi1 1Department of Ophthalmology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar City, Eastern Province, Saudi Arabia; 2Department of Ophthalmology, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran City, Eastern Province, Saudi Arabia; 3Department of Diagnostic and Interventional Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar City, Eastern Province, Saudi ArabiaCorrespondence: Majed Fehaid AlSubaie, Department of Ophthalmology, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran City, Eastern Province, Saudi Arabia, P.O. Box: 31952, Email [email protected]: Blowout fracture is defined as an internal orbital fracture that does not involve the orbital rim. This type of fracture results in the loss of tissue and disruption of the structure of the orbital wall. The symptoms and signs include pain, enophthalmos, diplopia, orbital emphysema, and ecchymosis. The surgeon’s main goal is to reconstruct the orbit in the best possible manner to achieve optimal anatomy and functionality of the orbit wall postoperatively. There is no consensus regarding the best material for use in surgical orbital reconstruction, despite the commercial availability of several biological and manufactured materials. Moreover, material selection is often based on the practitioner’s preferences/experience and patient safety. This study reported two cases of orbital fracture reconstruction using moldable methyl polymethacrylate as a bone surrogate. This material has already been used in dentistry, neurosurgery, and orthopedic surgery and is potentially hazard-free for orbit surgery.Case Presentation: Two victims of motor vehicle collisions presented with blowout orbital fractures. Cross-sectional imaging revealed inferior fractures involving the orbital wall. High-resolution tomographic modeling was used to plan surgical orbital floor reconstruction using moldable polymethyl methacrylate material. The short-term outcome of the implant appeared favorable at the one-year follow-up, based on regular patient monitoring and cross-sectional imaging assessment. Postoperative improvement with positive clinical outcomes was observed during both patients’ follow-up visits.Conclusion: Moldable polymethyl methacrylate can be used safely and effectively for reconstructive surgeries for the management of blowout orbital fractures. This new technique ensured a satisfactory short-term postoperative orbital configuration and tolerance and good esthetic and functional results without adverse effects. This customizable product is affordable and easy to fabricate.Keywords: implant, trauma, oculoplasty, magnetic resonance imaging, computed tomography

Keywords

• implant
• trauma
• oculoplasty
• magnetic resonance imaging
• computed tomography