Reconstruction of orbital floor fractures: comparison of individual prefabricated titanium implants and calvarial bone grafts.

We assessed fresh (< or = 2 weeks) and old (>2 weeks) orbital floor fractures and examined how selection of the implant affected the development of enophthalmos or the treatment of pre-existing enophthalmos. We conducted a retrospective review of 61 cases treated with calvarial bone grafting or individually prefabricated titanium mesh implants. The features of orbital floor fractures and orbital volume (OV) changes were analyzed by a 3-dimensional medical surface rendering image software system. The difference in OV before and after surgery was significant (P < 0.05) in fresh and old fractures treated with either calvarial bone or individually designed titanium mesh. The difference in OV between unaffected and postoperatively affected sides was not significant in the group that received the individually designed titanium mesh, but was significant in the group that received calvarial bone. Spearman rank correlation analysis indicated positive correlations between enophthalmos and postoperative OV changes after implantation of cranial bone in fresh fractures or titanium mesh in fresh and old fractures. The long-term degree of enophthalmos can be predicted with 3-dimensional medical surface rendering. Individual digitally designed titanium mesh is the proper choice of implant material to recover precise OV in fresh or older orbital fractures.