What Is the Incidence of Implant Malpositioning and Revision Surgery After Orbital Repair?

Purpose: Postoperative radiographic examinations are the gold standard in maxillofacial surgery, except in orbital reconstruction. Therefore, the purpose of this study was to estimate the frequency of implant malposition and revision operation after orbital repair. Materials and Methods: This retrospective cohort study was conducted in a level I trauma center at the University Hospital in Bern, Switzerland. To assess the incidence of malpositioning, a qualitative analysis of postoperative computed tomography scans, as well as comparative volumetric measurements of the orbits, was conducted. Furthermore, the incidence of and reason for secondary revision procedures were evaluated. Results: From September 2008 to December 2015, a total of 71 emergency patients (73 implants) were treated at the Department of Cranio-Maxillofacial Surgery with a titanium mesh (48 male patients; mean age, 56 years). The implant position was rated as poor in 17 cases (23%) by the qualitative analysis. The volumetric assessment showed no significant results. Revision intervention was needed in 12 patients (17%) because of an unsuccessful treatment outcome causing relevant clinical symptoms. Conclusions: Patients with large orbital defects who require surgical treatment with a titanium mesh are at risk of implant malposition. Because in this study, poor positioning of the implant is the main reason for surgical revision, we postulate that a postoperative radiographic control should be obtained routinely. Only then can long-term sequelae due to inadequate reconstruction be avoided. (C) 2017 American Association of Oral and Maxillofacial Surgeons