Nylon foil "wraparound" repair of combined orbital floor and medial wall fractures.

PURPOSE: To evaluate a technique of implanting a single 0.4-mm-thick nylon foil (Supramid) continuously across combined medial wall and floor fractures within weeks of orbital trauma. METHODS: This retrospective, interventional case series includes patients with combined medial wall and floor fractures with or without external orbital and facial fractures, without prior surgery, and who were in the early posttrauma phase. One hundred two orbits in 98 consecutive patients were treated with a "wraparound" technique. The surgical technique is provided in detail. Comatose patients, those with cranial nerve palsies, severe globe injury, anophthalmia, or previous repair of the same fractures were excluded. Patients underwent surgery from 5 to 21 days after trauma. Postoperatively (average, 6.2 months), patients were evaluated for enophthalmos, extraocular motility, and diplopia. RESULTS: In 101 of 102 orbits, normal globe position, and full extraocular motility without diplopia was accomplished. One orbit had persistent enophthalmos, requiring a second procedure. This same patient had ipsilateral restriction in extreme upgaze, but no diplopia symptoms. This orbit had complete loss of inferomedial strut support. Overall, strut loss was not a risk factor for subsequent enophthalmos. No other patient had globe malposition, restrictive myopathy, or diplopia. Implant migration, hemorrhage, fistula, or infection was not observed. The transconjunctival and canthal wounds were hidden and tolerated by all patients with no eyelid cicatrization, webbing, or malposition. CONCLUSIONS: The "wraparound" technique for 0.4-mm nylon foil implantation continuously across orbital floor and medial wall fractures was associated with almost no enophthalmos and diplopia in this series.

Dermal filler agents: a practical review.

PURPOSE OF REVIEW: Facial aging results from multiple microscopic (histopathologic) and macroscopic (anatomic) changes. Whereas skin care and traditional surgery have much to offer patients desiring cosmetic improvement, they can fail to adequately address certain signs of facial aging. Soft-tissue augmentation with dermal fillers can successfully address these signs of aging by filling soft-tissue defects caused by age, scar formation, or disease. All dermal fillers aim to achieve the same goal: long-lasting soft-tissue augmentation without side effects. Each dermal filler preparation available for patient use has unique compositions and characteristics that impact its proper handling, therapeutic results, potential complications, and, ultimately, its ideal use. This review surveys the currently available preparations for soft-tissue augmentation. RECENT FINDINGS: A review of the medical literature and manufacturers' information are included for dermal fillers currently approved for use by the US Food and Drug Administration. The composition, use, and potential limitation of each available preparation are reviewed. SUMMARY: Dermal filling agents offer an excellent option for management of certain facial cosmetic changes. Since a wide range of products with significantly different characteristics is available, the treating physician should have sound knowledge of them all.