Safety of titanium mesh for orbital reconstruction

During the past several decades, the standard of care for orbital reconstruction after trauma has been autogenous bone grafts. Complications of bone grafts, including donor site morbidities such as scar alopecia and graft resorption with delayed enophthalmos, have inspired an interest in the use of alloplastic substitutes such as titanium. Titanium's role in orbital reconstruction was limited originally to small orbital defects, and as an adjunct to bone grafts. More recently, clinical studies have documented the sole use of titanium mesh to reconstruct large orbital defects. This study sought to document further the safety and efficacy of titanium mesh in reconstructing large orbital defects after facial trauma, with more extensive follow-up compared with previous studies. In the current study, 55 patients with 67 orbital fractures underwent orbital reconstruction with titanium mesh over a 5-year period. Associated fractures were reduced anatomically and fixed rigidly. For the analysis, 44 patients with 56 orbital fractures had adequate follow-up (mean, 44 months). An abscess developed in one patient who received high-dose steroids for 72 hours before reconstruction. She was treated with broad-spectrum intravenous antibiotics and bedside incision and drainage, and did not require removal of the titanium mesh. No patient in the current series required removal of the titanium mesh. A single case of uncorrected enophthalmos was treated with bone grafting rather than mesh revision. Large orbital defects can be reconstructed using titanium mesh with good functional results and minimal risk for infection. This study covered the authors' first 5 years using titanium. They have now used titanium mesh in orbital reconstructions for more than 10 years, without any additional cases of infection.