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

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

Titanium Orbital Plates 2

AO Principles 3

Indications 3

Universal Orbital Floor Plate 4

Medial Wall Plate (left or right) 7

Orbital Plates 10

Synthes

Contourable Mesh Plate

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

2 Synthes Titanium Orbital Plates Technique Guide

Orbital Mesh Plate Orbital Floor Plate, small Orbital Floor Plate, medium Orbital Floor Plate, large

IntroductionInternal orbital plates are indicated when large portions ofthe internal orbit are destroyed and additional support forbone graft reconstruction must be considered. Orbital platesprovide a scaffold for accurate anatomic reconstruction ofthe bony orbital volume and shape. They may be utilized for acute orbital fractures or in late reconstruction of

Universal Orbital Floor PlateMedial Wall Plate

enopthalmos and ocular dystopia. The postbulbar constric-tion of the bony orbital cavity is often difficult to reconstructwith bone grafts alone. Internal orbital plates provide stablesupport for volumetric correction by spanning the middlesection of the inferomedial or medial internal orbit, providingstable support for bone grafts.

Synthes Orbital Mesh Plates for the Midfacial System are indicated for selective trauma of the midface and craniofacialskeleton; craniofacial surgery, reconstructive procedures; andselective orthognathic surgery of the maxilla and chin.

Synthes 3

Indications

AO Principles

In 1958 the AO formulated four basic principles, which have become the guidelines for internal fixation.1 Theseprinciples, as applied to the Titanium Orbital Plates, are:

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Stable fixationStability by rigid fixation (compression plating) or splintage,as the personality of the fracture and the injury requires.

Preservation of blood supplyPreservation of the blood supply to soft tissue and bone bycareful handling and gentle reduction techniques.

Early mobilizationEarly and safe mobilization of the part and the patient.

1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger. Manual of InternalFixation, 3rd Edition. Berlin: Springer-Verlag. 1991.

4 Synthes Titanium Orbital Plates Technique Guide

2Reduce orbital rim segments

Orbital rim segments are initially reduced and temporarilyfixed with wires, and their position secured with plateand screw fixation. The intact posterior orbit and restoredanterior rim provide positioning “landmarks” for preciseinternal plate and bone graft positioning.

Surgical Technique for Universal Orbital Floor Plate

1Expose lower orbit

Exposure of the lower orbit is provided by a subciliary inci-sion. When exposure of the upper medial wall, upper lateralwall, superior orbital rim or roof are required, a coronal incision is utilized. Subperiosteal intraorbital dissection of theanterior and middle third of the orbit is performed. Attach-ments of the medial canthal ligament, lacrimal system andthe contents of the inferior orbital fissure are avoided.

Orbital soft tissues are mobilized by gentle dissection underloupe magnification. Intact undisplaced bone in the posteriororbit is identified as an index to proper bone graft position.

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4Insert implant

The implant is inserted and positioned to span the orbital defect. The implant must not impinge on structures in theorbital fissures or on the optic nerve.

3Use template to contour implant

An aluminum template may be used to provide a model forbending and trimming the implant.

The titanium implant is bent with plate bending pliers or ribcontour forceps to match the contours of the aluminumbending template.

5Secure implant

The implant is fixed to the anterolateral internal orbit or inferior orbital rim with the appropriate diameter titaniumscrews inserted through the selected tabs.

Surgical Technique for Universal Orbital Floor Plate

6 Synthes Titanium Orbital Plates Technique Guide

7Close incision

The surgical incision is closed and normal postoperative protocol is followed.

6Test 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 im-pingement by the bone graft or implant on the musculofas-cial 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 mustbe placed on accurate anatomical reconstruction of bony orbital volume.

2

Reduce orbital rim segmentsOrbital rim segments are initially reduced and temporarilyfixed with wires, and their position secured with plate andscrew fixation. The intact posterior orbit and restored anterior rim providepositioning “landmarks” for precise internal plate and bonegraft positioning.

Synthes 7

Surgical Technique for Medial Wall Plate (left or right)

1Expose 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 coro-nal incision is utilized. Subperiosteal intraorbital dissection of the anterior and middle third of the orbit is performed.Attachments of the medial canthal ligament, lacrimal systemand the contents of the inferior orbital fissure are avoided.

Orbital soft tissues are mobilized by gentle dissection underloupe magnification. Intact undisplaced bone in the posteriororbit is identified as an index to proper bone graft position.

Surgical Technique for Medial Wall Plate (left or right)

8 Synthes Titanium Orbital Plates Technique Guide

3Use template to contour implant

An aluminum template may be used to provide a model forbending and trimming the implant.

The titanium implant is bent with plate bending pliers or ribcontour forceps to match the contours of the aluminumbending template.

4Insert implant

The implant is inserted and positioned to span the orbital defect. The implant must not impinge on structures in theorbital fissures or on the optic nerve.

5Secure implant

The implant is fixed to the anterolateral internal orbit or inferior orbital rim with the appropriate diameter titaniumscrews inserted through the selected tabs.

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6Test 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 musculo-fascial ligament system. These areas must be visualized toconfirm soft tissue freedom.

Note: Vertical position of the globe and globe projection can be adjusted by insertion of bone grafts. Emphasis mustbe placed on accurate anatomical reconstruction of bony orbital volume.

7Close incision

The surgical incision is closed and normal postoperative protocol is followed.

Orbital Plates

10 Synthes Titanium Orbital Plates Technique Guide

Titanium Orbital Mesh Plates

Screw Dia. Thickness Color

420.302 1.0 mm 0.2 mm Purple

420.303 1.0 mm 0.3 mm Teal

420.304 1.0 mm 0.4 mm Gold

421.302 1.3 mm 0.2 mm Purple

421.303 1.3 mm 0.3 mm Teal

421.304 1.3 mm 0.4 mm Gold

Titanium Orbital Floor Plates, anatomic, small,

Screw Dia. Thickness Color

420.401 1.0 mm 0.3 mm Teal

421.048 1.3 mm 0.3 mm Teal

Titanium Orbital Floor Plates, anatomic, medium

Screw Dia. Thickness Color

420.403 1.0 mm 0.3 mm Teal

421.043 1.3 mm 0.3 mm Teal

Titanium Orbital Floor Plates, anatomic, large

Screw Dia. Thickness Color

420.402 1.0 mm 0.3 mm Teal

421.049 1.3 mm 0.3 mm Teal

Titanium Universal Orbital Floor Plates

Screw Dia. Thickness Color

420.40 1.0 mm 0.4 mm Gold

421.040 1.3 mm 0.4 mm Gold

446.40 1.5 mm 0.6 mm Gold

420.302

421.040

420.401

420.403

420.402

Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer tohttp://www.synthes.com/Cleaning-sterilizationor 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 nonsterileor sterile packaged. Add “S” to catalog number for sterile product.

421.044

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Titanium Medial Wall Plates

Right Screw Dia. Thickness Color

420.45 1.0 mm 0.5 mm Gold

421.045 1.3 mm 0.5 mm Gold

446.45 1.5 mm 0.6 mm Gold

Left

420.44 1.0 mm 0.5 mm Gold

421.044 1.3 mm 0.5 mm Gold

446.44 1.5 mm 0.6 mm Gold

Titanium Contourable Mesh Plates, malleable, 1.3 mm

Dimensions Thickness Color

421.004 38 mm x 45 mm 0.4 mm Teal

421.007 100 mm x 100 mm 0.4 mm Teal

421.015 30 mm diameter 0.4 mm Teal

421.016 70 mm diameter 0.4 mm Teal

Titanium Contourable Mesh Plates, rigid, 1.3 mm

Dimensions Thickness Color

421.005 38 mm x 45 mm 0.4 mm Gold

421.008 100 mm x 100 mm 0.4 mm Gold

421.018 30 mm diameter 0.4 mm Gold

421.019 70 mm diameter 0.4 mm Gold

Titanium Contourable Mesh Plates, malleable, 1.5 mm

Dimensions Thickness Color

446.014 38 mm x 45 mm 0.4 mm Teal

446.017 100 mm x 100 mm 0.4 mm Teal

446.050 30 mm diameter 0.4 mm Teal

446.051 70 mm diameter 0.4 mm Teal

Titanium Contourable Mesh Plates, rigid, 1.5 mm

Dimensions Thickness Color

446.015 38 mm x 45 mm 0.6 mm Gold

446.018 100 mm x 100 mm 0.6 mm Gold

446.053 30 mm diameter 0.6 mm Gold

446.054 70 mm diameter 0.6 mm Gold

421.016

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