Treatment of orbital floor fracture using a periosteum–polymer complex

Summary 

Various materials for the reconstruction of bone defects in orbital floor fractures have been developed and applied clinically. Recently, reconstruction using polymers, in place of autologous bone and artificial materials, has been actively introduced, but there are problems, such as the size of reconstructable bone defects and the decomposition rate of polymers.

A basic study was performed on bone regeneration using a periosteum–polymer complex produced by attaching periosteum to a biodegradable polymer sheet.

In this study, patients with orbital floor fractures were evaluated clinically who had undergone reconstruction of orbital floor defects of the using a periosteum–polymer complex produced by applying periosteum to an Hydroxyapatite-[poly (l-lactide–ɛ-caprolactone)](HA-P (CL/LA)) sheet and the ilium in the previous 3 years.

A bone defect of less than 2.5cm² area was defined as small, that of 2.5–4cm² as intermediate, and that of more than 4cm² as a large bone defect. For small bone defects, hypoaesthesia in the infraorbital nerve was observed in one patient each of the periosteum–polymer complex and ilium groups. Regarding intermediate bone defects, diplopia and hypoaesthesia in the infraorbital nerve were observed in one patient in each of the two groups. For large bone defects, diplopia was observed in one patient each for the periosteum–polymer complex and ilium groups, and hypoaesthesia of the infraorbital nerve was only detected in one patient of the former group. Not more than 2mm of enophthalmos was detected in any patient. The anatomical eyeball position and eyeball movement were normal after surgical treatment using the periosteum–polymer complex, just as in reconstruction using autologous bone.

Keywords: orbital floor fracture, periosteum, polymer, ilium