Comparison of Porous Polyethylene Sheet(Medpor(R)) with Titanium Dynamic Mesh in the Treatment of Blow Out Fracture

The records of the patients with orbital wall fracture were reviewed from March 1997 through February 2001 in the department of plastic and reconstructive surgery, Yeungnam university medical center. One hundred thirty nine patients with blow out fracture were repaired by using porous polyethylene(Medpor(R)) or titanium dynamic mesh. Surgical effect of titanium dynamic mesh was evaluated and compared with that of Medpor(R) in the reconstruction of orbital wall fracture after follow up period of six months. The incidence of the orbital wall fracture was more common in men than in women. The traffic accident was most common cause of the fracture and the most common combined fracture was nasal bone fracture. The sites of fractures were the orbital floor in 51 patients, the medial wall in 18 patients, and both the medial wall and floor in 38 patients. Medpor(R) is easy to handle, shape, contour and position. Titanium dynamic mesh is good device in that it has for good structural stability, excellent strength, high biocompatibility and can be fixed easily. In conclusion, Medpor(R) was suitable for local defect in small fracture and titanium dynamic mesh was suitable for large defect in compound fracture

Reconstruction of Craniofacial Bone Defect with Titanium Dynamic Mesh

Reconstructing craniofacial bone defect is mainly done by autogenous bone graft and alloplastic implant insertion. Autogenous bone graft has the advantage of supplying the similar tissue to the bone defect area. But, due to several problems arose by using autogenous bone graft, the clinical use of the alloplastic implant has been increased. Among the various implants, titanium mesh has many advantages in chemical and physical properties. We have treated 26 patients with craniofacial bone defects (9 cases of cranium, 17 cases of orbital bone, and 9 cases of maxilla) using the titanium dynamic mesh (Howmedica Leibinger Inc.) and autogenous bone graft together in last two years. We followed up the patients for 3 to 18 months (mean, 8.2 months) and got satisfactory results with low complication rates. We found that the titanium dynamic mesh could be used successfully as an alternative substitute in reconstruction of the small to medium-sized defects in the craniofacial area. To maximize the success, certain surgical techniques had to be used. These techniques are as follow: 1.It required expertise to produce complex 3-dimensional contours of the craniofacial bone (frontal eminence, orbital margin etc.) with hand forming techniques. 2.In cranioplasty, at least 4 points fixation and enough soft tissue coverage were necessary. 3.In orbital wall reconstruction, mesh was inserted with the margins rested on the firm surrounding bone after meticulous trimming and molding to minimize complication such as enophthalmos. 4.In maxillary sinus reconstruction, attention was needed to prevent of soft tissue prolapse into the sinus and to aerate of the sinus. In conclusion, the excellent biocompatibility of titanium and easy application of the titanium dynamic mesh are outstanding characteristics in three-dimensional reconstruction of craniofacial bone defect with minimal morbidity and complications.