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The orbital floor and surgical efforts to change its shape/position are typically associated with fracture management. The thin nature of the bony thickness of the orbital floor and its support of the overlying eyeball may it prone to being pushed  downward into the maxillary sinus with direct trauma to the eyeball or cheekbone. Its reconstruction with such fracture displacements involves various techniques and materials to raise up the lowered/disrupted orbital floor and restore its natural horizontal position behind the infraorbital rim.

Another more elective reason for orbital floor augmentation is in facial asymmetry. When there is a vertical orbital dystopia present in facial asymmetry, and there often is, the orbital bony box is often a few millimeters lower. (as assessed  externally by a horizontal line across the pupils) The most accurate method for reconstruction of the low orbital floor is using a custom implant design approach from a 3D CT orbital scan of the patient. 

An alternative approach for orbital floor augmentation in facial asymmetry is to use readily available materials that are commercially available off-of-the shelf. One such material is ePTFE (expanded polytetrafluoroethylene), also known more commonly as Goretex. This is a material that has long been used in facial surgery and remains user friendly because of its favorable intraoperative properties of modification and adaptability. Its microporous surface characteristic encourages postoperative tissue adherence/bonding. It can be cut to the shape of the orbital floor, sewn together if more than a standard 2mm sheet thickness is needed, and does not require specific implant fixation.

While it still requires an intraoperative shaping and adaptation inside the orbital rims, its non-rigid and flexible characteristics makes it a viable option for modest orbital floor augmentations.       

Dr. Barry Eppley

Indianapolis, Indiana

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