Is There Risk Of Optic Nerve Injury With Custom Infraorbital-Malar Implants?

Q: Dr. Eppley, I think the cheek and infraorbital rim implants that I had placed in 2014 ended up moving upward from the orthognathic surgery I had in 2017. I just noticed this by comparing their current position to the position they were supposed to be in according to the original design, which I’m attaching. I think they are intruding upon the infraorbital cavity and causing some symptoms consistent with nerve compression. I’m worried that they are damaging the optic nerve. Could we have a consultation to talk about this? I think the implants might need to be repositioned surgically.

A:I have seen the IOM implant positions previously. They would not have moved upward from the effects of the LeFort osteotomy, that is just how they were placed. Custom implant placements rarely look exactly like the designs, close but never identical. One of the ‘downsides’ to see a postop scan is that patients can become aware of these discrepancies which exist in every case. The impetus for surgery should be what it looks like on the outside not what it looks like on a scan. It has been almost 10 years since those implants were placed and they would not cause any orbital compression being out of the orbital cavity and only sitting on the infraorbital rim. The optic nerve is located 35mm to 45mms behind the infraorbital rim so this is not an issue.

Dr. Barry Eppley

World-Renowned Plastic Surgeon