{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T18:46:45Z","timestamp":1769885205721,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Orbital fractures are common facial injuries that require precise reconstruction to restore both function and esthetics. Heterologous cortical lamina and titanium preformed meshes are widely used for orbital wall reconstruction; however, comparative data on their outcomes remain limited. Methods: This retrospective observational study analyzed 67 patients treated for orbital fractures at Santa Maria Hospital, Terni, between January 2021 and November 2024. Patients underwent orbital reconstruction using either a heterologous cortical lamina or titanium mesh. Clinical data, including demographics, trauma etiology, fracture characteristics, surgical approach, and postoperative complications were collected. Outcomes such as diplopia, enophthalmos, ocular motility, and sensory impairment were assessed preoperatively and postoperatively and compared between groups. Statistical analyses included Chi-square and Mann\u2013Whitney U tests, with logistic regression to identify risk factors for complications. Results: Accidental falls were the leading cause of injury (46.3%), with the orbital floor being the most commonly affected site (83.6%). Postoperative complications occurred in 15% of patients, with diplopia significantly reduced from 47.8% preoperatively to 10.4% postoperatively (p &lt; 0.05). Sensory impairment and motility restrictions also improved significantly. Patients reconstructed using heterologous cortical lamina experienced significantly fewer postoperative complications compared to those treated with titanium mesh (OR = 0.171, 95% CI: 0.023\u20130.799, p = 0.040). Conclusions: Both heterologous cortical lamina and titanium mesh provide effective orbital reconstruction; however, the heterologous cortical lamina was associated with fewer postoperative complications, particularly diplopia and sensory impairment. Material selection should consider the fracture complexity, patient characteristics, and potential long-term outcomes.<\/jats:p>","DOI":"10.3390\/jcm14134668","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T04:11:04Z","timestamp":1751429464000},"page":"4668","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Heterologous Cortical Lamina vs. Titanium Preformed Mesh Reconstruction in Orbital Fracture: A Retrospective Observational Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6048-1190","authenticated-orcid":false,"given":"Valentino","family":"Vellone","sequence":"first","affiliation":[{"name":"Department of Life Science, Health, and Health Professions, Universit\u00e0 degli Studi \u201cLink\u201d, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Elisa","family":"Giovannoni","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, University of Siena, Policlinico Santa Maria alle Scotte, Viale Mario Bracci, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, University of Siena, Policlinico Santa Maria alle Scotte, Viale Mario Bracci, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Committeri","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, \u201cS. Maria\u201d Hospital, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0386-5237","authenticated-orcid":false,"given":"Danilo","family":"Alunni Fegatelli","sequence":"additional","affiliation":[{"name":"Department of Life Science, Health, and Health Professions, Universit\u00e0 degli Studi \u201cLink\u201d, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Spallaccia","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, \u201cS. Maria\u201d Hospital, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"ref_1","unstructured":"Luibil, N., Lopez, M.J., and Patel, B.C. (2025). Anatomy, Head and Neck, Orbit. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E289","DOI":"10.1503\/cmaj.200657","article-title":"Orbital Floor Fracture","volume":"193","author":"Arthurs","year":"2021","journal-title":"Can. Med Assoc. J. CMAJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e850","DOI":"10.4317\/jced.60894","article-title":"The Pattern of Orbital Walls Fractures in North of Jordan","volume":"15","author":"Bataineh","year":"2023","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Asiri, M., and Aldowah, O. (2023). Ocular Findings in Patients with Orbital Fractures: A 1-Year Prospective Study in a Tertiary Center. Medicina, 59.","DOI":"10.3390\/medicina59061091"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ophtha.2020.06.065","article-title":"Characteristics of Orbital Floor Fractures in the United States from 2006 to 2017","volume":"128","author":"Iftikhar","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2147\/OPTH.S14972","article-title":"Orbital Fractures: A Review","volume":"5","author":"Joseph","year":"2011","journal-title":"Clin. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.tripleo.2007.12.022","article-title":"Orbital Floor Reconstruction: A Retrospective Study of 21 Cases","volume":"106","author":"Wang","year":"2008","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"355","DOI":"10.5999\/aps.2014.41.4.355","article-title":"Comparison of Absorbable Mesh Plate versus Titanium-Dynamic Mesh Plate in Reconstruction of Blow-Out Fracture: An Analysis of Long-Term Outcomes","volume":"41","author":"Baek","year":"2014","journal-title":"Arch. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1053\/joms.2000.18266","article-title":"Reconstruction of Orbital Fractures with Dehydrated Human Dura Mater","volume":"58","year":"2000","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100516","DOI":"10.1016\/j.adoms.2025.100516","article-title":"Orbital Roof Fractures: Considerations for Reconstruction","volume":"17","author":"Terenzi","year":"2025","journal-title":"Adv. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s12663-020-01407-x","article-title":"Reconstruction of Orbital Floor Fractures with Titanium Micromesh: Our Experience","volume":"21","author":"Chattopadhyay","year":"2022","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ijom.2006.11.002","article-title":"Reconstruction of Orbital Wall Defects: Critical Review of 72 Patients","volume":"36","author":"Aeppli","year":"2007","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/01.icu.0000136113.56288.87","article-title":"Epidemiology and Management of Orbital Fractures","volume":"15","author":"Cruz","year":"2004","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E853","DOI":"10.1097\/SCS.0000000000008786","article-title":"Maxillofacial Fractures in the Province of Terni (Umbria, Italy) in the Last 11 Years: Impact of COVID-19 Pandemic","volume":"33","author":"Spallaccia","year":"2022","journal-title":"J. Craniofacial Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1016\/j.bjoms.2020.07.001","article-title":"Prevalence and Severity of Orbital Blowout Fractures","volume":"58","author":"Khojastepour","year":"2020","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e752","DOI":"10.1097\/SCS.0000000000002208","article-title":"The Paradoxical Predominance of Medial Wall Injuries in Blowout Fracture","volume":"26","author":"Choi","year":"2015","journal-title":"J. Craniofacial Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/SCS.0b013e3182413edc","article-title":"Orbital Floor Reconstruction with Resorbable Polydioxanone Implants","volume":"23","author":"Gierloff","year":"2012","journal-title":"J. Craniofacial Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.joms.2019.09.025","article-title":"Does Early Repair of Orbital Fractures Result in Superior Patient Outcomes? A Systematic Review and Meta-Analysis","volume":"78","author":"Jazayeri","year":"2020","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sivam, A., and Enninghorst, N. (2022). The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review. Medicines, 9.","DOI":"10.3390\/medicines9010006"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13005-015-0096-3","article-title":"Orbital Floor Fractures\u2014Short\u2014and Intermediate-Term Complications Depending on Treatment Procedures","volume":"12","author":"Holtmann","year":"2016","journal-title":"Head Face Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1097\/SCS.0b013e31825aada1","article-title":"Materials Used for Reconstruction after Orbital Floor Fracture","volume":"23","author":"Avashia","year":"2012","journal-title":"J. Craniofacial Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1054\/bjom.2000.0500","article-title":"Isolated Orbital Blowout Fractures: Survey and Review","volume":"38","author":"Courtney","year":"2000","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.coms.2012.07.002","article-title":"Biomaterials for Reconstruction of the Internal Orbit","volume":"24","author":"Potter","year":"2012","journal-title":"Oral Maxillofac. Surg. Clin. North Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.amjoto.2013.02.006","article-title":"Use of Fracture Size and Soft Tissue Herniation on Computed Tomography to Predict Diplopia in Isolated Orbital Floor Fractures","volume":"34","author":"Shah","year":"2013","journal-title":"Am. J. Otolaryngol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/00006534-196701000-00002","article-title":"Orbital Blowout Fractures: A Ten-Year Survey","volume":"39","author":"Converse","year":"1967","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1001\/archotol.124.12.1398","article-title":"Selection of Materials for Orbital Floor Reconstruction","volume":"124","author":"Chowdhury","year":"1998","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/00006534-198206000-00006","article-title":"Use of Auricular Cartilage in Orbital Floor Reconstruction","volume":"69","author":"Constantian","year":"1982","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/00002341-199606000-00005","article-title":"Use of Demineralized Bone Implants in Orbital and Craniofacial Reconstruction and a Review of the Literature","volume":"12","author":"Neigel","year":"1996","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_29","first-page":"1022","article-title":"Incorporation of Titanium Mesh in Orbital and Midface Reconstruction","volume":"110","author":"Schubert","year":"2002","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/00001665-199307000-00007","article-title":"Use of Medpor Porous Polyethylene Implants in 140 Patients with Facial Fractures","volume":"4","author":"Romano","year":"1993","journal-title":"J. Craniofacial Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00001665-200105000-00009","article-title":"Resorbable Mesh in the Treatment of Orbital Floor Fractures","volume":"12","author":"Hollier","year":"2001","journal-title":"J. Craniofacial Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/00002341-199309000-00004","article-title":"Use of Vicryl (Polyglactin-910) Mesh Implant for Repair of Orbital Floor Fracture Causing Diplopia","volume":"9","author":"Mauriello","year":"1993","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1054\/ijom.2001.0067","article-title":"Effectiveness of Operative Treatment of Internal Orbital Wall Fracture with Polydioxanone Implant","volume":"30","author":"Kontio","year":"2001","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.joms.2005.09.013","article-title":"Bioresorbable Poly-l\/Dl-Lactide (P[L\/DL]LA 70\/30) Plates Are Reliable for Repairing Large Inferior Orbital Wall Bony Defects: A Pilot Study","volume":"64","author":"Lindqvist","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.18240\/ijo.2019.11.13","article-title":"Analysis of the Effect of Repair Materials for Orbital Blowout Fracture on Complications","volume":"12","author":"Xu","year":"2019","journal-title":"Int. J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3109\/01676830.2012.736597","article-title":"Orbital Adherence with Titanium Mesh Floor Implants: A Review of 10 Cases","volume":"32","author":"Kersey","year":"2013","journal-title":"Orbit"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/IOP.0b013e3181929b6e","article-title":"Orbital Adherence Syndrome Secondary to Titanium Implant Material","volume":"25","author":"Lee","year":"2009","journal-title":"Ophthalmic Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4668\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:02:40Z","timestamp":1760032960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4668"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":37,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134668"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134668","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]}}}