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Abstract Objective To describe a novel method of medial fixation of titanium mesh with a right‐angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods. Methods The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed. Results Mean follow‐up was for 15.7 months (range, 9–22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p .05). No specific complications were reported. Conclusion We propose a novel method of zygomatic medial fixation of titanium mesh with a right‐angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh. Level of Evidence Level III (Retrospective comparative study).

Objective: To describe a novel method of medial fixation of titanium mesh with a right‐angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods. Methods: The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed. Results: Mean follow‐up was for 15.7 months (range, 9–22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p <.05). The exposure of titanium mesh occurred in two patients in group B. The self‐evaluation of facial symmetry for 23 patients showed no significant difference between group A (7.75 ± 0.71) and group B (6.68 ± 1.30; p >.05). No specific complications were reported. Conclusion: We propose a novel method of zygomatic medial fixation of titanium mesh with a right‐angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh. Level of Evidence: Level III (Retrospective comparative study). [ABSTRACT FROM AUTHOR]

In orbital floor reconstruction, the need for the orbital implant to reach the exact position of the posteromedial ledge is essential, but owing to the complex anatomy of the region, visualisation of the ledge may be difficult. Several morphometric studies, both radiographic and cadaveric, have calculated a mean length from the orbital rim to the ledge. However, those linear measurements are unreliable and possess a higher margin of error for intraoperative guidance. This study attempts to triangulate the position of the posterior ledge from three easily accessible and reproducible points on the orbit and tries to provide a better guideline. A total of 50 patients (25 male and 25 female) with no history of orbital trauma or orbital surgery were selected randomly for this study. Computed tomography (CT) of both orbits, was done from three anatomically consistent and reproducible points: the infraorbital rim just above the infraorbital foramen (point A), hamulus lacrimalis (point B), and the most anterior point of the inferior orbital fissure (point C). The distance from these landmarks to the posterior ledge was measured using DICOM imaging software. A polygonal template was fabricated using the data obtained, which was used for intraoperative guidance. The mean (SD) distance to the posterior ledge from point A was 32.99 (1.35) mm, from point B was 31.36 (1.31) mm, and from point C was 20.19 (1.40) mm. There were no significant differences between left and right orbit or between male and female subjects. The template guides the shape, size, and direction of the orbital implant, reducing the risk of undersized or misplaced implants. [ABSTRACT FROM AUTHOR]