Titanium Mesh Orbital Floor Reconstruction Improves Enophthalmos and Hypoglobus Following Zygomaticomaxillary Complex Fractures with Concomitant Orbital Floor Involvement and Isolated Orbital Floor Fractures: A Retrospective Cohort Study

Abstract

Background: Post-traumatic enophthalmos and hypoglobus represent significant complications following orbital floor fractures, occurring both as isolated injuries and in association with zygomaticomaxillary complex (ZMC) fractures. The comparative effectiveness of orbital floor reconstruction between these fracture patterns remains incompletely understood.

Purpose: To evaluate the effectiveness of titanium mesh orbital floor reconstruction in improving post-traumatic enophthalmos and hypoglobus in patients with ZMC fractures with concomitant orbital floor fractures compared to isolated orbital floor fractures.

Study Design, Setting, Participants: This retrospective cohort study analyzed patients who underwent titanium mesh orbital floor reconstruction between January 2018 and December 2022 at a tertiary care center. Inclusion criteria comprised adult patients with orbital floor fractures presenting with enophthalmos ≥2mm and/or hypoglobus ≥2mm, with minimum 6-month follow-up.

Predictor Variable: Fracture pattern (ZMC with orbital floor fractures versus isolated orbital floor fractures).

Main Outcome Variables: Primary outcomes were improvement in enophthalmos measured by Hertel exophthalmometry and hypoglobus assessed by pupillary level differences at 6 months and 1 year post-operatively. Secondary outcomes included extraocular muscle function, diplopia resolution, and patient satisfaction.

Results: Twenty patients were analyzed (10 ZMC with orbital floor fractures, 10 isolated orbital floor fractures). Mean age was 32.4 ± 11.2 years with male predominance (70.0%). Significant improvement in enophthalmos was achieved in both groups (ZMC group: 4.2 ± 1.3mm to 1.2 ± 0.8mm, p=0.002; isolated group: 3.9 ± 1.2mm to 1.0 ± 0.7mm, p=0.001). Hypoglobus improved significantly (ZMC group: 3.3 ± 1.1mm to 0.8 ± 0.6mm, p=0.004; isolated group: 3.1 ± 0.8mm to 0.7 ± 0.5mm, p=0.002). Extraocular muscle function normalized in 85% of patients at 1 year. Overall success rates were 80.0% for ZMC group and 90.0% for isolated fractures (p=1.000).

Conclusions: Titanium mesh orbital floor reconstruction effectively improves post-traumatic enophthalmos and hypoglobus with comparable success rates regardless of fracture pattern. Both ZMC-associated and isolated orbital floor fractures demonstrate excellent functional and aesthetic outcomes with low complication rates.