Alloplastic reconstruction of orbital floor fractures: a systematic review and pooled outcomes analysis

Orbital floor defects from traumatic injuries can be successfully repaired surgically utilizing alloplastic implants. The objective of this study was to conduct a comprehensive systematic review of alloplastic implant materials utilized in the repair of orbital floor fractures stratified by material type, indication for surgery, and outcomes in all reported cases to date. A comprehensive systematic review of published literature on alloplastic periorbital implant studies was conducted utilizing Medline/PubMed database without timeframe limitations. Articles were reviewed in full by multiple authors and outcomes data were collected. A total of 11 studies (n = 585 patients) were identified to meet the inclusion criteria. Overall, 25 total surgical complications (4.3%) were noted, including infection, inflammation, graft migration or explantation, and hematoma. Overall, porous polyethylene (PPE) implants were associated with the highest rate of infection (2.0%) compared with all other implant types analyzed. Poly-l-lactic acid (PLLA) implants were associated with the highest rate of graft explantation (5.9%). Explantation was required in a total 0.6% of all implants (n = 3). Alloplastic implants are a reliable means of reconstructing the orbital floor following trauma. It is imperative for surgeons to understand the relative risks for each type of implant to develop postoperative complications in order to optimize outcomes. Level of evidence: Level III, therapeutic study