The Combined Use of Pericranial Flap and Titanium Mesh in Reconstruction of Large Medial Orbital Defects

Large Nasoorbital defects are challenging defects to reconstruct. In the context of chronic infection and inflammation and postradiation exposure, these defects have a high rate of fistula and chronic drainage. Many techniques have been previously described, but none have completely solved this issue.

In our experience, the pericranial flap has been easy to implement and efficacious with the adjunction of titanium mesh in these contexts. In this paper, we present our experience using this technique in two cases of different pathologies where we used the combined pericranial flap and titanium mesh for reconstruction of large bony and soft tissue defects of the naso-orbital region. The first case was a complication of Wegner's granulomatosis of the nasal cavity with bilateral inferomedial large orbital wall defect. The second was a complication of endonasal endoscopic surgery with a unilateral large bony defect.

The vivid blood supply and the versatility of the flap are ideal in this setting. Also, its flexibility makes it suitable for use intraorbitally with no effect on vision, or on ocular movements. Combining this flap with titanium mesh provides more support, which prevents further herniation of any of the orbital contents into the nasal cavity. This combination also has the potential to be used in a myriad of repairs in the midface area.