Orbital cutaneous fistula as a delayed complication after fracture repair surgery: a case-based literature review

To describe the epidemiological changes in orbital cutaneous fistula formation and emphasize the importance of selecting implant materials for orbital fracture repair surgeries. Eight patients were included in this study. All patients had a history of orbital fracture surgery, with Medpor implanted in 3 patients, Medpor titanium in 2 patients, titanium mesh in 2 patients, and bioresorbable material in 1 patient. The average duration between orbital cutaneous fistula formation and the first operation was 4.58 ± 2.93 years. Orbital cutaneous fistulas were found around the orbital region (6 cases in the infraorbital region, 1 case in the lateral orbital region, and 1 case in the supraorbital region). The Valsalva maneuver induced purulent secretion from the external fistula opening. Other implications include enophthalmos, limited eye mobility, diplopia, ectropion, acquired deformities of the epicanthal, nasolacrimal occlusion, and chronic dacryocystitis. CT imaging reveals inflammatory effusion in the surrounding paranasal sinuses (e.g., the maxillary, ethmoid and frontal sinus) before the second operation. The implanted porous materials were found intraoperatively to be poorly vascularized, with surrounding scar formation. Postoperative pathology revealed focal granulomatous inflammation. After the removal of the implants and the fistula resection operation, the functional defects were essentially repaired, with permanent impairment of appearance. Orbital cutaneous fistula is a late complication of orbital reconstruction surgery that requires more attention during long-term follow-up.