Technique Guide. Titanium Orbital Plates. For reconstruction of medial wall and orbital floor fractures.

Transcription

1 Technique Guide Titanium Orbital Plates. For reconstruction of medial wall and orbital floor fractures.

2 Table of Contents Introduction Titanium Orbital Plates 2 AO Principles 3 Indications 3 Surgical Technique Universal Orbital Floor Plate 4 Medial Wall Plate (left or right) 7 Product Information Orbital Plates 10 Synthes

3 Titanium Orbital Plates. For reconstruction of medial wall and orbital floor fractures. Introduction Internal orbital plates are indicated when large portions of the internal orbit are destroyed and additional support for bone graft reconstruction must be considered. Orbital plates provide a scaffold for accurate anatomic reconstruction of the bony orbital volume and shape. They may be utilized for acute orbital fractures or in late reconstruction of enopthalmos and ocular dystopia. The postbulbar constriction of the bony orbital cavity is often difficult to reconstruct with bone grafts alone. Internal orbital plates provide stable support for volumetric correction by spanning the middle section of the inferomedial or medial internal orbit, providing stable support for bone grafts. Orbital Mesh Plate Orbital Floor Plate, small Orbital Floor Plate, medium Orbital Floor Plate, large Medial Wall Plate Universal Orbital Floor Plate Contourable Mesh Plate 2 Synthes Titanium Orbital Plates Technique Guide

4 AO Principles In 1958 the AO formulated four basic principles, which have become the guidelines for internal fixation. 1 These principles, as applied to the Titanium Orbital Plates, are: Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. Stable fixation Stability by rigid fixation (compression plating) or splintage, as the personality of the fracture and the injury requires. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Early mobilization Early and safe mobilization of the part and the patient. Indications Synthes Orbital Mesh Plates for the Midfacial System are indicated for selective trauma of the midface and craniofacial skeleton; craniofacial surgery, reconstructive procedures; and selective orthognathic surgery of the maxilla and chin. 1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger. Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag Synthes 3

5 Surgical Technique for Universal Orbital Floor Plate 1 Expose lower orbit Exposure of the lower orbit is provided by a subciliary incision. When exposure of the upper medial wall, upper lateral wall, superior orbital rim or roof are required, a coronal incision is utilized. Subperiosteal intraorbital dissection of the anterior and middle third of the orbit is performed. Attachments of the medial canthal ligament, lacrimal system and the contents of the inferior orbital fissure are avoided. Orbital soft tissues are mobilized by gentle dissection under loupe magnification. Intact undisplaced bone in the posterior orbit is identified as an index to proper bone graft position. 2 Reduce orbital rim segments Orbital rim segments are initially reduced and temporarily fixed with wires, and their position secured with plate and screw fixation. The intact posterior orbit and restored anterior rim provide positioning landmarks for precise internal plate and bone graft positioning. 4 Synthes Titanium Orbital Plates Technique Guide

6 3 Use template to contour implant An aluminum template may be used to provide a model for bending and trimming the implant. The titanium implant is bent with plate bending pliers or rib contour forceps to match the contours of the aluminum bending template. 4 Insert implant The implant is inserted and positioned to span the orbital defect. The implant must not impinge on structures in the orbital fissures or on the optic nerve. Synthes 5

7 Surgical Technique for Universal Orbital Floor Plate 5 Secure implant The implant is fixed to the anterolateral internal orbit or inferior orbital rim with the appropriate diameter titanium screws inserted through the selected tabs. 6 Test impingement A forced duction test must be completed and compared to similar ductions performed before and after dissection. Any change in resistance must be presumed to be an impingement by the bone graft or implant on the musculofascial ligament system. These areas must be visualized to confirm soft tissue freedom. Note: Vertical position of the globe and globe projection can be adjusted by insertion of bone grafts. Emphasis must be placed on accurate anatomical reconstruction of bony orbital volume. 7 Close incision The surgical incision is closed and normal postoperative protocol is followed. 6 Synthes Titanium Orbital Plates Technique Guide

8 Surgical Technique for Medial Wall Plate (left or right) 1 Expose lower orbit Exposure of the lower orbit is provided by a subciliary incision. When exposure of the upper medial wall, upper lateral wall, superior orbital rim or roof are required, a coronal incision is utilized. Subperiosteal intraorbital dissection of the anterior and middle third of the orbit is performed. Attachments of the medial canthal ligament, lacrimal system and the contents of the inferior orbital fissure are avoided. Orbital soft tissues are mobilized by gentle dissection under loupe magnification. Intact undisplaced bone in the posterior orbit is identified as an index to proper bone graft position. 2 Reduce orbital rim segments Orbital rim segments are initially reduced and temporarily fixed with wires, and their position secured with plate and screw fixation. The intact posterior orbit and restored anterior rim provide positioning landmarks for precise internal plate and bone graft positioning. Synthes 7

9 Surgical Technique for Medial Wall Plate (left or right) 3 Use template to contour implant An aluminum template may be used to provide a model for bending and trimming the implant. The titanium implant is bent with plate bending pliers or rib contour forceps to match the contours of the aluminum bending template. 4 Insert implant The implant is inserted and positioned to span the orbital defect. The implant must not impinge on structures in the orbital fissures or on the optic nerve. 8 Synthes Titanium Orbital Plates Technique Guide

10 5 Secure implant The implant is fixed to the anterolateral internal orbit or inferior orbital rim with the appropriate diameter titanium screws inserted through the selected tabs. 6 Test for impingement A forced duction test must be completed and compared to similar ductions performed before and after dissection. Any change in resistance must be presumed to be an impingement by the bone graft or implant on the musculofascial ligament system. These areas must be visualized to confirm soft tissue freedom. Note: Vertical position of the globe and globe projection can be adjusted by insertion of bone grafts. Emphasis must be placed on accurate anatomical reconstruction of bony orbital volume. 7 Close incision The surgical incision is closed and normal postoperative protocol is followed. Synthes 9

11 Orbital Plates Titanium Orbital Mesh Plates Screw Dia. Thickness Color mm 0.2 mm Purple mm 0.3 mm Teal mm 0.4 mm Gold mm 0.2 mm Purple mm 0.3 mm Teal mm 0.4 mm Gold Titanium Orbital Floor Plates, anatomic, small, Screw Dia. Thickness Color mm 0.3 mm Teal mm 0.3 mm Teal Titanium Orbital Floor Plates, anatomic, medium Screw Dia. Thickness Color mm 0.3 mm Teal mm 0.3 mm Teal Titanium Orbital Floor Plates, anatomic, large Screw Dia. Thickness Color mm 0.3 mm Teal mm 0.3 mm Teal Titanium Universal Orbital Floor Plates Screw Dia. Thickness Color mm 0.4 mm Gold mm 0.4 mm Gold mm 0.6 mm Gold Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to or to the below listed inserts, which will be included in the shipping container: Processing Synthes Reusable Medical Devices Instruments, Instrument Trays and Graphic Cases DJ1305 Processing Non-sterile Synthes Implants DJ1304 Implants are made of commercially pure (CP) titanium and are available nonsterile or sterile packaged. Add S to catalog number for sterile product Synthes Titanium Orbital Plates Technique Guide

12 Titanium Medial Wall Plates Right Screw Dia. Thickness Color mm 0.5 mm Gold mm 0.5 mm Gold mm 0.6 mm Gold Left mm 0.5 mm Gold mm 0.5 mm Gold mm 0.6 mm Gold Titanium Contourable Mesh Plates, malleable, 1.3 mm Dimensions Thickness Color mm x 45 mm 0.4 mm Teal mm x 100 mm 0.4 mm Teal mm diameter 0.4 mm Teal mm diameter 0.4 mm Teal Titanium Contourable Mesh Plates, rigid, 1.3 mm Dimensions Thickness Color mm x 45 mm 0.4 mm Gold mm x 100 mm 0.4 mm Gold mm diameter 0.4 mm Gold mm diameter 0.4 mm Gold Titanium Contourable Mesh Plates, malleable, 1.5 mm Dimensions Thickness Color mm x 45 mm 0.4 mm Teal mm x 100 mm 0.4 mm Teal mm diameter 0.4 mm Teal mm diameter 0.4 mm Teal Titanium Contourable Mesh Plates, rigid, 1.5 mm Dimensions Thickness Color mm x 45 mm 0.6 mm Gold mm x 100 mm 0.6 mm Gold mm diameter 0.6 mm Gold mm diameter 0.6 mm Gold Synthes 11

13 Synthes CMF 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 9/12 J1828-D