Unusual Osteogenesis of Titanium and Porous Polyethylene Orbital Floor Mesh Following Orbital Fracture Repair: A Case Report

Orbital floor implants are commonly used to repair fractures, but complications such as infection, diplopia, or implant misplacement may develop. We describe a 68 year-old male presenting with chronic orbital pain and purulent discharge many years after undergoing repair of an orbital floor fracture with a titanium and porous polyethylene implant. Imaging and surgical findings demonstrated a malpositioned orbital floor implant in the maxillary sinus with resultant chronic infection and complete bony encapsulation of the implant – a previously-unreported phenomenon. The implant was retrieved using a combined transconjunctival, endoscopic, and Caldwell-Luc trans-antral approach. We propose that chronic low-grade inflammation and mechanical stress induced by the implant misplacement are likely causes of the observed unusual osteogenesis. Other factors including titanium surface characteristics, immune signaling, and systemic determinants have been associated with pathologic osteogenesis and can provide a broader context for this unusual finding. This case emphasizes the potential for undesirable osteogenesis in the orbit and the importance of keeping such rare complications in the differential. It also emphasizes the need for multi-approach surgical technique and multidisciplinary planning in treating complex implant-related infections and revisions.