For repairing orbital fracture, is nylon foil “all that” or is titanium, the “Lamborghini of implants,” the better choice? In Saturday’s lively Oculoplastics Subspecialty Day discussion on orbital fracture repair (Ocu03), Hui Bae Harold Lee, MD, and Nicholas R. Mahoney, MD, presented the benefits of low-tech (standard nylon foil) versus high-tech (customized titanium) implants.
Low-Tech: Standard Nylon Foil Implants
Flexible and conforming. As pliable sheets, nylon implants easily conform to the interior of the orbit, making them ideal for wrapping simple internal wall fractures. Their flexible nature also avoids the square-orbit issue often seen with some older and more rigid implants.
Low-risk. Nylon foil sheets are relatively forgiving, with low risk of postoperative complications such as diplopia or enophthalmos. As Dr. Lee put it, “It’s hard to make a patient worse.”
Cost-effective. With rising national health care costs, affordability is an important factor to consider. Whereas customized implants can cost upward of $1,000, a nylon foil implant averages around $16.
No support is no problem. While Dr. Lee admitted that nylon foil does not provide much in the way of extra support, he argued that the purpose of the foil is to bridge gaps and create separation in areas within the orbit, not to provide additional stabilization.
High-Tech: Patient-Specific Titanium Implants
Completely customizable. In addition to having a wide selection of preshaped commercially available options, titanium implants can be manually formed around a custom-printed model or 3-D printed to a particular individual’s exact specifications. This preoperative customizability makes them fast and efficient to implant.
Porous and biocompatible. Titanium has low reactivity in human tissues. In addition, titanium implants have a mesh structure, allowing for blood flow and drainage and thereby reducing the risk of postoperative inflammation.
Strong and supportive. Unlike nylon foil, titanium implants provide significant rigidity and strength, which is ideal for areas with structural losses. By spanning from one area to the next, rather than lying directly on top of other structures, titanium implants reduce the risk of adherence complications.
Potential cons. Titanium implants are substantially more costly than nylon foil. In addition, they don’t leave any room for error, making it relatively easy to make a patient worse if a titanium implant is placed by the wrong hands.
Low-tech vs. high-tech: There is no wrong choice. In the end, the doctors agreed that there is no right or wrong answer when it comes to orbital fracture repair. Each type of implant has value in different scenarios, and regardless of which option is chosen, having a skilled oculoplastic surgeon behind the knife is the most important factor. —Lauren Jarem, MS
Financial disclosures: Hui Bae Harold Lee, MD: None; Nicholas R Mahoney, MD: None.
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