Immediate orbital floor reconstruction with titanium mesh plates and free flaps after total maxillectomy

The method of reconstructing the orbital floor in immediate maxillary reconstruction after total maxillectomy is an important consideration for restoration of eyeball functions. Materials available for orbital floor reconstruction include free iliac bone grafts, vascularized costal cartilage combined with a rectus abdominis musculocutaneous flap, pedicled calvarial bone grafts, and titanium mesh plates. We performed immediate orbital floor reconstruction with titanium mesh plates and free soft-tissue flaps in 14 patients from 1992 through 2005. The patients ranged in age from 34 to 79 years and included 10 men and 4 women. Reconstruction was immediately successful in all cases. Eyeball functions were preserved, except in 2 cases in which blindness developed immediate postoperatively owing to extirpation of the primary tumor that had invaded the orbital contents. In 12 cases, eye movement was not disturbed, and neither eyeball dislocation nor double vision was observed. However, the titanium mesh used to reconstruct the bony contour of the zygoma was exposed in 1 case about 4 years after surgery, necessitating removal of the mesh plate and further reconstruction. A titanium mesh plate is thin and pliable and sufficiently strong to sustain the orbital contents. We believe that a titanium mesh plate, when combined with a free soft-tissue flap, is a reliable material for reconstruction of the orbital floor. However, because of the risk of exposure, mesh plates should not be used to reconstruct facial contours.