Reconstruction of orbital wall defects with bioactive glass plates.

PURPOSE: Synthetic bioactive glass (BAG) is used in many surgical applications. Special bioactive glasses do not favor microbial growth. This study evaluated the clinical outcome of bioactive glass plates in reconstructive orbital surgery.

PATIENTS AND METHODS: In a retrospective series of 49 patients, 35 orbital floors and 6 orbital medial and superior walls were reconstructed after fronto-orbital trauma, and 8 patients were treated with BAG plates after fronto-orbital tumor resection. These patients were evaluated in terms of reconstruction materials, complications, and functional outcomes.

RESULTS: During the 2-year follow-up, 3 of the 35 orbital floor trauma reconstructions were reoperated (9%) because of diplopia, and new reconstructions with BAG were performed. In all of the 8 patients with tumors and in 6 of the patients undergoing orbital wall reconstruction, the plates were in the correct position after reconstruction, and none had to be removed. One patient with a benign tumor and 7 of the 8 patients with malignant tumors survived to the 2-year follow-up.

CONCLUSIONS: Reconstructive surgery of the orbit is one of the most demanding challenges in head and neck surgery. In orbital defect reconstruction, a BAG plate seems to be a well-tolerated and reliable reconstruction material alternative; however, BAG plates are brittle and rigid, and cannot be molded and shaped by a surgeon. The use of a stainless steel template of equal shape and size to a BAG plate is recommended to ameliorate this deficiency.