This is a description of a new method for fixating the bone flap during a lateral orbitotomy. The technique involves the use of an absorbable lactide plate. This is warmed in a water bath to allow trimming and moulding to the correct contour, and then bone holes are drilled in line with holes in the plate. Biodegradable lactide pins hold the plate securely to the bone and are inserted using an ultrasonic handpiece. This drives the pins into the bone and simultaneously melts the pin heads which then fuse with the plate. Ten patients underwent bone fixation using this technique with an average follow-up time of 12.9 months. Three patients developed postoperative oedema and inflammation, which was treated with oral steroids, but in one of these the inflammation persisted for 10 months. However, no patient required removal of the plate, and there were no visual or ocular motility complications. Biodegradable plates have been used extensively in maxillo-facial surgery, but have not been described previously for lateral orbitotomy closure. The main drawbacks are lack of strength compared to titanium, and inflammation. The former is unlikely to be a major concern given the lack of load bearing of the lateral rim, but the inflammatory reaction is more worrisome. This series had a high rate of 30%, but the numbers were small and other larger series have reported lower rates of this complication. The cost is comparable to titanium plating, but more expensive than suturing. Cosmetically the lactide plates have a thinner profile than titanium, and there is no need for further surgery to remove them. There is a learning curve for the ultrasonic pin placement, but once mastered the technique is no more difficult or time-consuming than titanium plating.

Biodegradable fixation of the orbital rim after lateral orbitotomy.
Davies BW, Mollman RA, Gonzalez MO, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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