Reconstruction of Orbital Floor Fracture Using Solvent-Preserved Bone Graft (original) (raw)

Alternative Methods for Reconstruction of Orbital Floor Defect other than Bone Graft

Orbital fractures are one of the most frequent consequences following midfacial trauma. If not treated they can lead to serious optical complications as; double vision (diplopia), restriction of ocular motility, enophthalmos. Autogenic bone graft although still wide and effectively used for reconstruction of fractured orbital wall present some disadvantages such as morbidity of donor site, resorption, time consuming procedure and long post-operative care. Because of that introduction of new materials for orbital reconstruction seems to be desirable.

Autogenous Grafts for Orbital Floor Reconstruction: A review

International Journal of Oral and Craniofacial Science, 2017

Orbital fractures are relatively common midfacial injuries encountered in urban areas. Patients usually are seen with periorbitaloedema and restricted eye movements with or without changes in vision. A wide range of autogenous materials can be used in the reconstruction of orbital defects including bone grafts, cartilages and fascia each having its own strengths and weaknesses. The purpose of this paper is to provide a systematic literature review on various autogenous materials used for orbital fl oor reconstruction.

Use of nonresorbable alloplastic implants for internal orbital reconstruction

Journal of Oral and Maxillofacial Surgery, 2004

Fractures of the internal orbit are common facial injuries. They can range in size from a small crack in the floor to extensive multiple wall defects. Their diagnosis and treatment planning have been greatly improved over the past 30 years because of the wide availability of computed tomography (CT). CT allows an assessment of the location of the fracture/defect and the amount of orbital soft tissue prolapse into the adjacent sinuses. When significant internal orbital defects are not reconstructed, malposition of the ocular globe can occur. Enophthalmos and hypoglobus are the most common consequences of internal orbital defects of the floor and/or medial wall. Surgical reconstruction of the fractured, displaced, or missing orbital walls has been shown to prevent these complications in the acute setting and restore globe position in the chronic setting.

Secondary Orbital Reconstruction in Patients with Prior Orbital Fracture Repair

Ophthalmic Plastic & Reconstructive Surgery, 2016

Purpose: To evaluate clinical characteristics, preoperative imaging findings, pre-and post-operative outcomes, and satisfaction of patients requiring secondary reconstruction after inadequate primary orbital fracture repair. Methods: Retrospective review of 13 patients requiring secondary orbital reconstruction following unsatisfactory primary repair. Primary outcomes were postoperative changes in enophthalmos, hypo-or hyper-globus, superior sulcus deformity, and restrictive strabismus. Secondary outcomes included patient satisfaction. Results: Of 13 patients, 9 patients had primary orbital implants, and 4 patients did not. Of the 9 with implants, 6 had inferior displacement posteriorly, 2 had superior displacement posteriorly, and 1 had good position but had entrapped orbital tissues beneath it. Findings from primary surgery included enophthalmos (12/13), hypoglobus (10/13), hyperglobus (1/13), superior sulcus deformity (9/13), restricted supraduction (12/13), and restricted infraduction (7/13). Mean preoperative enophthalmos and hypoglobus were 4.4 ± 2.6 mm and 2.9 ± 1.4 mm, respectively. Secondary reconstruction resulted in mean reduction of enophthalmos by 3.4 ± 1.4 mm (p < 0.001), of hypoglobus by 2.9 ± 1.5 mm (p < 0.001), and of hyperglobus by 1 mm (n = 1). All 9 patients had resolution of their superior sulcus deformity. Of 12 cases with restricted ocular motility, all had improvements in postoperative motility following secondary surgery. Mean improvement in supraduction and infraduction was 1.8 ± 1.0 points (p < 0.001) and 1.4 ± 1.3 points (p = 0.025), respectively. Twelve patients reported being very satisfied or satisfied with secondary surgery; 1 patient was neutral. Conclusions: This study demonstrates that secondary orbital reconstruction can achieve excellent functional and cosmetic results with high patient satisfaction and minimal complications. Secondary reconstruction of previously repaired orbital fractures should be considered when clinically indicated.

Reconstruction of Orbital Floor Fractures With Maxillary Bone

Archives of Otolaryngology–Head & Neck Surgery, 1998

To evaluate the use of autogenous maxillary bone for the repair of orbital floor defects secondary to blunt facial trauma. Design: Retrospective case series of 41 patients with a mean follow-up of 1.7 years. Setting: Major metropolitan teaching hospital. Patients: Forty-one consecutive patients who underwent repair of orbital floor fractures with maxillary antral wall bone grafts. Main Outcome Measures: Presence of diplopia, orbital dystopia, implant extrusion, enophthalmos, infection, and donor site complications. Results: On follow-up clinical examinations, none of the 41 patients presented with any evidence of orbital dystopia or complications relative to the implant or donor site. Two patients had persistent enophthalmos, and 4 had persistent infraorbital nerve paresthesia. Postoperative computed tomographic scans in 12 patients revealed an adequate maintenance of orbital volume without any evidence of resorption of the graft. Conclusion: The use of maxillary antral wall bone for the repair of orbital floor fractures is a highly reliable technique that carries minimal morbidity.

Dried bone allograft and orbital fracture reconstruction

Clinical Ophthalmology, 2020

Orbital fracture is a common eye injury related to increasing incidence of accidents. Indications for surgical intervention include: enophthalmos, diplopia and compromised cosmetic appearance. Orbital reconstruction procedure requires bone defect exposure and typically repairs with an implant such as: silicone sheet, Medpore, Titan mesh, bony allograft and other biomaterials. Dried bone grafts can be safe in terms of sterility, immunity and stability. In this report, we review 17 cases of orbital fractures repaired with dried bone implants. Postoperative outcomes were good with increased orbital volume and reduced diplopia. CT scans confirmed long term implant integration into recipients’ orbit. Dried bone graft allografts should be considered as a safe and inexpensive effective material for orbital fracture reconstruction.

Long-Term Sequelae after Surgery for Orbital Floor Fractures

Otolaryngology–Head and Neck Surgery, 1999

A surgical technique involving exact repositioning and rigid fixation is required for the reduction of fractures of the orbital floor. Even then, sequelae may be present long after the trauma. The aim of this study was to establish the frequency and type of sequelae after surgery for orbital floor fractures and to investigate the extent to which the method of surgery had any impact on the severity of the sequelae. A questionnaire was sent to all 107 patients (response rate 77%) 1 to 5 years after the injury. Further clinical data were obtained from the patients' charts. Eighty-three percent of the patients were affected by some kind of permanent sequelae in terms of sensibility, vision, and/or physical appearance. A high frequency of diplopia (36%) was related to the reconstruction of the orbital floor with a temporary “supporting” antral packing in the maxillary sinus, a technique which has now been abandoned at our department in favor of orbital restoration with sheets of poro...