Reconstruction of severe medial orbital wall fractures using titanium mesh plates placed using transcaruncular-transconjunctival approach: a successful combination of 2 techniques.

PURPOSE: To prospectively evaluate the use of titanium mesh plates in a combined transcaruncular-transconjunctival approach for severe medial orbital wall fractures.

PATIENTS AND METHODS: We analyzed the clinical and radiologic data of 10 patients with isolated blow-out orbital fractures. The fracture location was the medial wall in 5 (50%) and the floor/medial wall in 5 (50%). Of the 10 patients, 8 (80%) were treated using 3-dimensionally preformed orbital titanium mesh plates and 2 (20%) with nonpreformed radial orbital mesh plates fixed at the inferior orbital rim with 1 or 2 monocortical screws (diameter 1.3 mm).

RESULTS: All the patients had satisfactory and anatomically correct orbital wall reconstruction as assessed on the immediate postoperative computed tomography scan. None of the patients experienced ophthalmic complications related to the transcaruncular-transconjunctival approach or developed enophthalmos as determined using Hertel exophthalmometry. One patient (10%) developed a nonhandicapping diplopia related to post-traumatic muscular contusion of the medial rectus muscle.

CONCLUSIONS: The present study has demonstrated that titanium mesh plates placed using a combined transcaruncular-transconjunctival approach for the reconstruction of severe medial orbital wall fractures results in a high rate of success.