Retrospective comparison of one-stage and two-stage orbital reconstruction in patients suffering from combined injuries of the midface.

Abstract

Reconstruction of the bony orbit in patients with combined midface injuries is frequently discussed in the current literature. Two main concepts can be distinguished: single-stage reconstruction, usually with a hand-bent titanium orbital mesh, and two-stage reconstruction, in which osteosynthesis of the zygomaticomaxillary complex (ZMC) is followed by orbital reconstruction with a virtually-planned, patient-specific titanium implant in a second surgery. This study aimed to compare one-stage and two-stage surgical approaches on combined midface fractures regarding postoperative diplopia. A total of 58 patients treated with one-stage (n = 29) or two-stage (n = 29) reconstruction of the ZMC and orbit were included, and their postoperative course over five months was retrospectively analysed. A descriptive quantitative analysis of the course of occurrence of diplopia was recorded to calculate the success of orbital repair in complex midface fractures including the orbit. The two workflows differed in the prevalence of postoperative clinical diplopia and eyelid complications. Multiple factors affect the decision whether or not to reconstruct the orbit first, and in the same intervention as the associated midface fracture. Thorough evaluation of each individual patient with a patient-specific choice of surgical concept is crucial, and includes multiple factors.