Dersleri yüzünden oldukça stresli bir ruh haline sikiş hikayeleri bürünüp özel matematik dersinden önce rahatlayabilmek için amatör pornolar kendisini yatak odasına kapatan genç adam telefonundan porno resimleri açtığı porno filmini keyifle seyir ederek yatağını mobil porno okşar ruh dinlendirici olduğunu iddia ettikleri özel sex resim bir masaj salonunda çalışan genç masör hem sağlık hem de huzur sikiş için gelip masaj yaptıracak olan kadını gördüğünde porn nutku tutulur tüm gün boyu seksi lezbiyenleri sikiş dikizleyerek onları en savunmasız anlarında fotoğraflayan azılı erkek lavaboya geçerek fotoğraflara bakıp koca yarağını keyifle okşamaya başlar


Unexpected Presentation of a Twenty Year Old Orbital Floor Reconstruction
ISSN: 2161-119X
Otolaryngology: Open Access

Like us on:

Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business
  • Letter To Editor   
  • Otolaryngol (Sunnyvale) 2016, Vol 6(4): 260
  • DOI: 10.4172/2161-119X.1000260

Unexpected Presentation of a Twenty Year Old Orbital Floor Reconstruction

Ioan Davies* and Paul Chambers
Department of Head and Neck surgery, Bradford Teaching Hospitals, UK
*Corresponding Author: Ioan Davies, BDS, MFDS (RCSed), Department of Head and Neck surgery, Bradford Teaching Hospitals, UK, Tel: 07891705189, Email:

Received: 23-Aug-2016 / Accepted Date: 24-Aug-2016 / Published Date: 31-Aug-2016 DOI: 10.4172/2161-119X.1000260


A thirty-nine year old man presented with a six month history of persistent infra-orbital infection which had failed to resolve following multiple courses of oral antibiotics.

Examination revealed an erythematous swelling with an associated discharging sinus within the right infraorbital crease alongside diplopia in strained upward gaze. Pupillary levels were equal however the lower right eyelid was depressed and exhibited a historical scar.

Further questioning revealed a history of post-traumatic orbital floor reconstruction twenty years prior to presentation.

Computed tomography imaging unexpectedly revealed two separate orbital floors (Figure 1) thought to have formed secondary to a silicone sheet reconstruction. Both the new orbital floor (Figure 2) and the implant were removed and histopathological results revealed only chronic suppurative granulation tissue. Post-operatively the infection had resolved, however no improvement was seen regarding his diplopia.


Figure 1: Coronal view of pre-operative CT scan showing right sided neo-orbital floor encasing the silastic sheet.


Figure 2:Post-operative image of the neo-orbital floor following it’s removal from the right orbital floor.

Several materials are available for reconstructing orbital floor defects, including autologous bone grafts, silicone elastomer, porous polyethylene, titanium mesh and more recently PEEK.

Although cheap and easily accessible, silicone elastomers are associated with a higher complication rate making their current use controversial [1].

Frequently reported complications include persistent pain, chronic infection, migration, and extrusion of the implant [2]. Other reported complications include dacryocystitis, skin fistula, orbit maxillary communications and cyst formation [3].

Morrison et al reviewed 311 patients reconstructed with silastic implants and found that implant removal was necessary in 13.2% of patients due to persistent infection, pain, extrusion, and diplopia [2] Yun et al conducted a review of 115 patients treated with silastic sheets; 4.3% needed implant removal due to infection, hematoma, displacement, or extrusion, with a mean removal time of 23.3 months [4].

The majority of post-implantation silicone complications become evident in the early post-operative phase, but complications have been reported up to 31 years later [2,5] However, to our knowledge no report of a secondary orbital floor formation has ever been made.

This case highlights the importance of being vigilant of potentially rare underlying causes of infection whilst having an awareness of historical treatment methods and how they can still impact upon current practice.


  1. Moon SJ, Suh HS, Park BY, Kang SR (2014) Safety of Silastic Sheet for Orbital Wall Reconstruction. Archives of Plastic Surgery 41: 362-365.
  2. Morrison AD, Sanderson RC, Moos KF (1995) The use of silastic as an orbital implant for reconstruction of orbital wall defects: review of 311 cases treated over 20 years. J Oral MaxillofacSurg 53: 412–417.
  3. Bourgault S, Bordua-Robert M, MolgatYM (2001) Recurrent orbital cyst as a late complication of silastic implant for orbital floor fracture repair. Can J Ophthalmol 46: 368-369.
  4. Yun HK, Yi S, Joh SP, Ahn ST, Lim P (2001) Complications after open reduction of blow-out fracture using silicone sheet. J Korean Cleft Palate-CraniofacAssoc 2: 72–76.
  5. Verma, S, Garg A,Nastri A (2014) Orbitomaxillary mass after repair of the orbital floor. Br J Oral MaxillofacSurg 52: 977-979.

Citation: Davies I, Chambers P (2016) Unexpected Presentation of a Twenty Year Old Orbital Floor Reconstruction. Otolaryngol (Sunnyvale) 6:260. Doi: 10.4172/2161-119X.1000260

Copyright: ©2016 Davies I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.