Orbital Adherence Syndrome following the Use of Titanium Precontoured Orbital Mesh for the Reconstruction of Posttraumatic Orbital Floor Defects

Abstract

Orbital blowout fractures are a common occurrence following orbital trauma. Depending on the size of the defect and the contents that have herniated or incarcerated, possible sequelae include enophthalmos, diplopia, dystopia, and entrapment. Surgical intervention aims to prevent or alleviate this through the use of a bone graft or an alloplastic implant to reconstitute the continuity of the orbit. However, in doing so, the implant itself may result in the unexpected adherence of the periorbita, resulting in orbital adherence syndrome. We present two cases of orbital adherence syndrome following the use of titanium mesh for orbital floor reconstruction. In both cases, we also delineate the management of this syndrome. Our first patient reported good recovery after surgical intervention to relieve the tethering to the titanium mesh and subsequent placement of a smooth interface implant. The other patient was managed nonsurgically with resolution of symptoms. We highlight possible signs that might suggest the need for early surgical intervention. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery.