Double-sheeted silicone plate reconstruction for inferomedial orbital wall fractures: a retrospective single-center case series with a historical reference cohort.

OBJECTIVE: To evaluate postoperative enophthalmos and ocular motility following Double Silicone Procedure (DSP), contextualized against an earlier Silicone Balloon Fixation (SBF) cohort from a time-separated single-center experience. METHODS: We conducted a single-center retrospective case series (April 2000 - December 2024) across a technique transition (SBF before April 2014; DSP thereafter). Primary outcomes were patient-reported enophthalmos (graded 0-4) and postoperative ocular motility (HAR%). Between-era differences were descriptively analyzed using Hodges-Lehmann estimates with 95% Confidence Intervals (95% CIs). RESULTS: Thirty patients met the inclusion criteria (DSP, n = 10; SBF, n = 20). The median postoperative enophthalmos score was 0 (Interquartile Range [IQR] 0-0) in the DSP group (n = 10) and 1 (IQR 0-1) in the SBF group (n = 13) (Hodges-Lehmann Δ = -1.0; 95% CI -1.0 to 0.0; p = 0.008). Among DSP patients with postoperative Hertel exophthalmometry measurements (n = 8), no patient exhibited clinically perceptible enophthalmos (>2 mm); the median Hertel exophthalmometry difference was -1.0 mm (IQR -1.0 to 0.0). Postoperative HAR% was 92.1% (IQR 86.0-100.0) after DSP and 88.4% (IQR 80.4-97.0) after SBF (p = 0.397). No optic nerve injuries, infections, or implant-related complications were observed in either group. CONCLUSION: In this single-center experience across a surgical technique transition, DSP demonstrated favorable postoperative outcomes, with reduced enophthalmos and preserved ocular motility. Although earlier cases served as a historical reference, these exploratory findings support DSP as a safe and practical option for complex inferomedial orbital wall fractures.