Complications after Open Reduction of Blow-out Fracture using Silicone Sheet

ABSTRACT

Many kinds of alloplastic implants have been used for surgical reconstruction of orbital wall fractures. Although complication rates caused by them are known to be higher than that by autologous grafts such as calvarian bone graft, there are few reports about collective cases for individual alloplastic implants. A retrospective review was performed on 115 patients who underwent orbital blow-out fractures reconstruction with silicone sheet(Silastic(R)) implants between 1989 and 1998. After the follow-up period from 1 month to 5 years, six patients(4.3%) had to undergo reoperations for implant removal because of complications such as infection, hematoma, displacement and extrusion of implant. Symptoms of Silicone sheet complications were progressive periorbital swelling, tenderness, proptosis, hypesthesia and persistant diplopia. Complications were diagnosed by history of Silicone sheet insertion, physical examination and follow-up facial bone or orbit CT. Mean duration of onset was 23.3 months. In all cases of complication, implants were surgically removed and proper antibiotics were used postoperatively. The symptoms subsided immediately without any other sequelae. The reconstruction of blow-out fractures with silicone rubber implant may cause serious late complications such as infection, displacement, hematoma, migration and extrusion. Therefore, careful follow up is nesessary, and prompt sheet removal should be considered first, if such complications are confirmed.