Orbital blowout fracture: rationale of surgical technique

Delayed complications of silicone implants used in orbital fracture repairs

PURPOSE

To report a series of patients who developed late complications secondary to silicone implants used in orbital fracture repairs and review the literature.

DESIGN

Retrospective interventional case series.

METHODS

Analysis of records of patients who developed complications following repair of orbital wall fractures with silicone implants.

RESULTS

Over a 5-year period, 4 patients were seen with complications arising from a silicone orbital implant. There were 3 males and 1 female whose ages ranged from 41-73 years. The time interval between initial insertion of implant and development of complications was 1.5, 6, 10, and 20 years. The complications noted were worsening diplopia, recurrent orbital cellulitis, lower lid retraction with restricted upgaze, and orbital abscess. Computed tomographic scans demonstrated the implant in all cases. Histologic examination revealed nonspecific chronic inflammation and fibrosis in all cases and foci of squamous epithelium in one case. Treatment included surgical removal of the implant, resulting in complete resolution or significant improvement in symptoms and signs in all cases.

CONCLUSION

The use of silicone implants is associated with a wide range of complications, which may occur many years following the original surgery. Surgical removal of the implant usually leads to resolution of symptoms. Given the potential of silicone implants to cause delayed complications, their use in orbital fracture repair is not recommended.

Late reaction to silicone following reconstruction of an orbital floor fracture

This report presented the clinical and radiographic findings, the surgical management, and the histologic features of a chronic inflammatory lesion that developed in response to a Silastic orbital floor implant placed 13 years previously. A review of the literature supported the fact that implanted solid film polymers can precipitate a continuous, chronic inflammatory response that is dynamic and that may be exacerbated by numerous factors.

Lacrimal obstruction after migration of orbital floor implant

A 7-year-old girl developed epiphora, recurrent purulent conjunctivitis, and dacryocystitis 32 months after the repair of a traumatic orbital floor fracture. Dacryocystography and surgical exploration revealed that migration of the orbital floor implant had caused obstruction of the nasolacrimal duct at the sac. Migration of the implant was probably due to a failure to anchor the implant properly to bone.