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      Effectiveness of Cross-Linked Acellular Dermal Matrix to Correct Post-Traumatic Enophthalmos

      Journal of Craniofacial Surgery
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Background:

          The use of an acellular dermal matrix is rarely reported in orbital wall fracture reconstruction. This study aimed to share the author’s experience with the cross-linked acellular dermal matrix as an allograft material for enophthalmos correction.

          Methods:

          In this retrospective study, the author evaluated the medical records and 3-dimensional facial computed tomography scans of patients with enophthalmos caused by neglected orbital fractures between May 2021 and June 2022. Facial computed tomography scans confirmed the clinical diagnosis of enophthalmos. A single surgeon performed all surgical operations. In all patients, the author accessed the orbital floor via subciliary incision while approaching the medial wall with a retrocaruncular incision. After fully exposing the lesion, the author used a 1.0-mm-thick cross-linked acellular dermal matrix (ADM) (MegaDerm; L&C Bio, South Korea). After trimming the cross-linked ADM to a proper size, the author implanted the ADM into the lesion.

          Results:

          During May 2021 and June 2022, 3 cases of enophthalmos were successfully corrected with cross-linked ADM at the author’s hospital. All patients were improved clinically and radiologically.

          Conclusion:

          This is the first study to show the effectiveness of cross-linked ADM for the correction of enophthalmos.

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          Most cited references12

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          Use of Acellular Allogenic Dermal Matrix (MegaDerm) in Orbital Wall Reconstruction: A Comparison With Absorbable Mesh Plate and Porous Polyethylene.

          The selection of materials for orbital wall reconstruction has been a matter of debate. This study aimed to evaluate the effectiveness of an acellular allogenic dermal matrix (ADM) as an orbital wall reconstruction material and to compare the results of orbital wall reconstruction with the ADM to those of reconstruction with the more widely used absorbable mesh plate and porous polyethylene. We retrospectively reviewed the clinical charts and computed tomography images of 73 patients who underwent orbital reconstruction at 1 institution between March 2013 and February 2014. In the ADM group, the mean defect size of 29 patients was 2.89 cm. After orbital wall reconstruction with ADM, patients with preoperative enophthalmos (7 patients), limited range of eyeball movement (6 patients), and diplopia (12 patients) showed improvements. In the comparative study, the 3 groups showed no significant differences with respect to age distribution (P = 0.522), defect size (P = 0.455), and preoperative findings such as enophthalmos (P = 0.811), diplopia (P = 0.357), and limited range of eyeball movement (P = 0.795). All the preoperative symptoms improved in every group, and in the ADM group, no complication was observed during the postoperative follow-up. ADM is a biocompatible material that combines the flexibility and rigidity required to support the orbital soft tissue. Therefore, it could be an excellent alternative material for orbital wall reconstruction.
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            Low-Cost, Three-Dimensionally–Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction

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              Is Open Access

              Correction of Posttraumatic Enophthalmos

              Management of posttraumatic enophthalmos can present as a challenge to the reconstructive surgeon, particularly in cases of late presentation. This article reviews the pertinent anatomy of the orbit, diagnostic modalities, indications for surgery, and surgical approaches as they relate to the treatment of posttraumatic enophthalmos. Internal orbital reconstruction has evolved to an elegant procedure incorporating various biologic or alloplastic implants, including anatomical pre-bent implants. Successful repair of late enophthalmos has been demonstrated in multiple recent studies and is likely related to the precision with which orbital anatomy can be restored.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Journal of Craniofacial Surgery
                Ovid Technologies (Wolters Kluwer Health)
                1049-2275
                2023
                July 2023
                March 20 2023
                : 34
                : 5
                : e449-e451
                Article
                10.1097/SCS.0000000000009290
                c11a9d7f-26a2-4ceb-85b0-c2430cdfddb6
                © 2023
                History

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