![]() Methylprednisolone (250 mg) was infused intravenously at the end of the surgery, and postoperative systemic antibiotics were administered. All implants were soaked in gentamicin solution before implantation. All patients had uneventful blowout fracture repair using porous polyethylene sheets (Medpor®, Porex Surgical, Newnan, GA, USA) of 1 mm thickness for correction of enophthalmos and diplopia, using a transconjunctival approach for the inferior wall and a transcaruncular approach for the medial wall fracture. Orbital blowout fracture occurred after automobile traffic accidents (two patients), sports injury (one patient), and an accidental fall (one patient). None had a significant past medical history or current disease. The Samsung Medical Center Institutional Review Board approved the retrospective review of the patients’ data, and the study adhered to the tenets of the Declaration of Helsinki.Īll patients were male with mean age of 49 years (range 35–69 years) (Table 1). The clinical presentations, radiographic findings, histopathological findings, and treatment and outcome data were collected. Delayed onset inflammation was regarded if an implant-related inflammation occurred 6 months later than the fracture repair. Medical records of four consecutive patients who developed delayed complications related with porous polyethylene sheets after orbital blowout fracture repair at Samsung Medical Center between 20 were retrospectively reviewed. In this case series, we describe the clinicopathological features of inflammation after orbital blowout fracture repair using porous polyethylene sheets, which is rarely encountered after a long postoperative duration in immunocompetent patients. In addition, the latter case involved an immunocompromised patient. The former case developed several bouts of inflammation from 6 months after fracture surgery, and finally had the implant removed 36 months after the original surgery. reviewed 21 explanted periorbital biomaterials due to nonresolving infection or exposure and reported one immunosuppressed patient who had granulomatosis with polyangiitis with an infected porous polyethylene sheet after 3 years. reported a patient who developed delayed onset recurrent implant infection leading to implant removal. In a retrospective review of 30 patients, Ng et al. Long-term durability and safety of porous polyethylene implants for orbital fracture reconstruction have been reported however, there have been very few reported late complications. described six cases of late infection/inflammation in supramid implants ranging from 8 to 16 years after implantation. reported inflammation and infection that developed 1.5–20 years after silicone implants for orbital fracture repair. ![]() Low-grade or fulminant inflammation could complicate blowout fracture repair related with the implant.ĭelayed complications related to alloplastic implant materials in orbital blowout fracture repairs are infrequent and generally appear as isolated case reports. Conclusionsĭelayed complications with porous polyethylene sheets used in orbital blowout fracture repair may occur many years following the initial surgery in immunocompetent patients. Histopathological findings revealed chronic inflammatory changes with fibrosis, and one patient had foreign body granuloma with culture positive Staphylococcus aureus. All patients underwent implant removal and two of these patients with paranasal sinusitis had sinus surgery. Three patients developed peri-implant abscesses and one patient had a soft tissue mass around the implant. Chronic and subacute orbital inflammatory signs were noted in two patients and acute fulminant orbital inflammation was found in two patients. Blowout fracture repair was complicated with implant-related inflammation 10 months, 2 years, 3 years, and 8 years after surgery. Four male patients were included with a mean age of 49 years (range 35–69 years). This is a retrospective review of clinical presentations, radiographic findings, histopathological findings, treatments, and outcomes of patients who developed delayed complications in orbital blowout fracture repair using porous polyethylene sheets. Delayed inflammation related to porous polyethylene sheet implants is very rare and no case series of this condition have been reported. ![]() Porous polyethylene implants are commonly used in orbital blowout fracture repair because of purported biocompatibility, durability, and low frequency of complications. ![]()
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