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Boro S, Suri MP, Mathew AK. PDS Plate Versus Bone Graft in Orbital Floor Reconstruction: A Prospective Study to Identify the Better Alternative. Indian J Otolaryngol Head Neck Surg 2022; 74:4699-4705. [PMID: 36742492 PMCID: PMC9895357 DOI: 10.1007/s12070-021-03036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
The objective of this study is to compare the effect and outcome of orbital floor reconstruction with bone graft and PDS plate. A prospective cohort study was conducted at B J Medical College, Civil Hospital, Ahmedabad from 1st September 2013 to 28th February 2016 by the Department of Burns and Plastic Surgery on patients (N = 35) who reported with orbital floor fracture. Diplopia, enophthalmos, infection rate, hospital stay, and donor site complications were considered. The above variables were assessed as predictors of outcome in the management (PDS vs. bone graft). Inferential statistics was done by chi-square test. The significance level was kept at 5%. Follow-up of 35 patients (2 years), 26 male, and 9 females aged 26-65 years were made. Diplopia and enophthalmos were the main criteria's in the study and neither of them showed any statistical significance. Donor site morbidity was noted in 3 patients among the bone graft group which was managed conservatively. Both the bone graft and PDS plate in orbital floor reconstruction is comparable in almost all aspects of our study. No statistically significant differences were found between the two groups. Pain and wound site infection are possible complications when a bone graft is used as the reconstructive option.
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Affiliation(s)
- Sumanjith Boro
- Department of Plastic and Reconstructive surgery, Dr B Borooah Cancer Institute, Guwahati, A Unit of TMC and a Grant-in-Aid institute of DAE, Mumbai, India
| | - Manav P. Suri
- Department of Plastic and Reconstructive Surgery, BJ Medical College, Ahmedabad, India
| | - Anil K. Mathew
- Department of Plastic and Reconstructive surgery, Dr B Borooah Cancer Institute, Guwahati, A Unit of TMC and a Grant-in-Aid institute of DAE, Mumbai, India
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Alasady MS, Kanj A, Kanj AEH. Evaluation of the outcomes of using iliac bone graft for reconstruction of traumatic orbital floor fractures. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY = JOURNAL DE LA THERAPEUTIQUE DES POPULATIONS ET DE LA PHARMACOLOGIE CLINIQUE 2022; 29:e71-e78. [PMID: 35848199 DOI: 10.47750/jptcp.2022.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Orbital floor fracture is common in facial trauma patients. Although treated through surgical repair, the orbital floor fractures are associated with risk of persisting sensibility disorders, enophthalmos, and permanent diplopia due to complex anatomy of the orbit, time of surgery, and the reconstructive material used for such repairing.Failure of early recognition and treatment of these traumatic injuries may result in functional and cosmetic problems. Autogenous bone grafts are the gold standard for reconstruction of maxillofacial defects. The iliac crest is also considered the most ideal donor site for bone grafting when a large amount of bone is needed. OBJECTIVE To assess the outcome of early repair of orbital floor fractures regarding enophthalmos, double vision, extrusion, and gait disturbance. PATIENTS AND METHODS A total of 15 patients, all with orbital floor fracture, were enrolled, of which 12 of them were having pure blow-out fractures and 3 patients had impure blow-out fractures. All had undergone primary surgical reconstruction of the orbital floor by autogenous anterior iliac crest within 5-14 days of the injury. RESULTS The results were as follows: Postoperative complications at recipient site included diplopia (13.3%), enophthalmos (6.7%), and extrusion (6.7%). At the donor site, one patient had pain and the other had gait disturbances, both relieved within 1 month after treatment. CONCLUSIONS Less complications were reported postoperatively with the use of nonvascularized autogenous iliac bone graft.
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Affiliation(s)
- Mukhalled Salim Alasady
- Department of Oral and Maxillofacial Surgery, College of dentistry, Al-Ayen university, Thi-Qar, Iraq;
| | - Amer Kanj
- Department of Oral and Maxillofacial Surgery, College of dentistry, Al-Ayen university, Thi-Qar, Iraq
| | - Abd El Hadi Kanj
- Department of Orthodontics, College of Dentistry, Al-Ayen University, Thi-Qar, Iraq
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Bourry M, Hardouin JB, Fauvel F, Corre P, Lebranchu P, Bertin H. Clinical evaluation of the efficacy of materials used for primary reconstruction of orbital floor defects: Meta-analysis. Head Neck 2020; 43:679-690. [PMID: 33145908 DOI: 10.1002/hed.26518] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this network meta-analysis (NMA) was to compare the clinical results obtained after primary reconstruction of orbital floor fractures (OFF) using different materials. METHODS PubMed, Cochrane, and Google Scholar databases were screened from 1989 to 2019. For a study to be eligible, it had to evaluate two or more materials and report the following clinical parameters: diplopia and/or enophthalmos and/or other complications. RESULTS Nine studies involving 946 patients presenting with an OFF were included. After the surgical procedure, 105 patients (11%) had diplopia, while 43 patients (4.5%) suffered from enophthalmos. The NMA revealed that less postoperative diplopia and enophthalmos were obtained either by using polydioxanone (PDS), or a polymer of l-lactic acid and dl-lactic acid (P[L/DL]LA), or porous polyethylene, or titanium mesh compared with the use of autologous bone grafts. CONCLUSION P(L/DL)LA and PDS seem to be the best options for small and intermediate defects, whereas the association of porous polyethylene and titanium should be preferred for larger defects.
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Affiliation(s)
- Maeva Bourry
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France
| | | | - Fabien Fauvel
- Department of Maxillofacial Surgery, Saint-Nazaire Hospital, Saint-Nazaire, France
| | - Pierre Corre
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.,Regenerative Medicine and Skeleton (RMeS), Faculty of Dental Sciences, Nantes, France
| | - Pierre Lebranchu
- Department of Ophthalmology, Nantes University Hospital, Nantes, France.,UMR 6597 CNRS, Image and Video Communication Team, Polytech-Nantes, Nantes, France
| | - Hélios Bertin
- Department of Maxillofacial Surgery, Nantes University Hospital, Nantes Cedex 1, France.,Bone sarcoma and remodeling of calcified tissues (PhyOs, UMR 1238), Faculty of Medicine, Nantes Cedex, France
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O'Connell JE, Hartnett C, Hickey-Dwyer M, Kearns GJ. Reconstruction of orbital floor blow-out fractures with autogenous iliac crest bone: a retrospective study including maxillofacial and ophthalmology perspectives. J Craniomaxillofac Surg 2014; 43:192-8. [PMID: 25534042 DOI: 10.1016/j.jcms.2014.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 11/20/2022] Open
Abstract
This is a 10-year retrospective study of patients with an isolated unilateral orbital floor fracture reconstructed with an autogenous iliac crest bone graft. The following inclusion criteria applied: isolated orbital floor fracture without involvement of the orbital rim or other craniofacial injuries, pre-/post-operative ophthalmological/orthoptic follow-up, pre-operative CT. Variables recorded were patient age and gender, aetiology of injury, time to surgery, follow-up period, surgical morbidity, diplopia pre- and post-operatively (Hess test), eyelid position, visual acuity, and the presence of en-/or exophthalmos (Hertel exophthalmometer). Twenty patients met the inclusion criteria. The mean age was 29 years. The mean follow up period was 26 months. No patient experienced significant donor site morbidity. There were no episodes of post-operative infection or graft extrusion. Three patients had diplopia in extremes of vision post-operatively, but no interference with activities of daily living. One patient had post-operative enophthalmos. Isolated orbital blow-out fractures may be safely and predictably reconstructed using autogenous iliac crest bone. The rate of complications in the group of patients studied was low. The value of pre- and post-operative ophthalmology consultation cannot be underestimated, and should be considered the standard of care in all patients with orbitozygomatic fractures, in particular those with blow-out fractures.
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Affiliation(s)
- John Edward O'Connell
- Department of Oral and Maxillofacial Surgery, St James Hospital, James' St, Dublin 8, Ireland.
| | - Claire Hartnett
- Department of Ophthalmology, Mid Western Regional Hospital, Limerick, Ireland
| | - Marie Hickey-Dwyer
- Department of Ophthalmology, Mid Western Regional Hospital, Limerick, Ireland
| | - Gerard J Kearns
- Department of Oral and Maxillofacial Surgery, St James Hospital, James' St, Dublin 8, Ireland
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Garg V, Giraddi GB, Roy S. Comparison of efficacy of mandible and iliac bone as autogenous bone graft for orbital floor reconstruction. J Maxillofac Oral Surg 2014; 14:291-8. [PMID: 26028849 DOI: 10.1007/s12663-014-0654-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 06/23/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study evaluated and compared the efficacy of mandible and iliac bone as autogenous bone graft for correction of orbital floor fractures. PATIENTS AND METHODS Twenty patients who suffered orbital floor fractures took part in the study. The subjects enrolled in the study sustained both isolated orbital floor fracture and orbital floor fracture associated with fracture of zygomatico-maxillary complex. Each inferior orbital wall was reconstructed using either a mandible bone graft or an iliac graft. Mandibular symphysis was opted as a donor site for graft harvest from mandible and anterior iliac crest for the iliac group. CT scans were taken before the operation. Inclusion criteria consisted of at least 2 months postsurgical follow-up, pre- and post-surgical photographic documentation, and complete medical records regarding inpatient and outpatient data. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, and restriction of ocular movements before and after treatment. We also considered the time required for the harvest of the grafts and the donor site complications. A comparative study was carried out using Chi square test and student t test. We considered P value <0.05 to be statistically significant. RESULTS Ten iliac crest grafts and ten mandible bone grafts were placed. The mean age of the patients was 33.1 years. 80 % of the patients were males. The most common complication of orbital floor fracture was diplopia, followed by enophthalmos and restriction of ocular movements. The post operative results were compared after 2 months of the surgery. In iliac crest group, diplopia got corrected in six out of seven patients (85 %), enophthalmos in four out of five patients (80 %) and restricted ocular movement showed 100 % correction. While in mandible group, diplopia and ocular movement showed 100 % correction and enophthalmos got corrected in five out of six patients (83 %). No statistically significant differences were found between the two groups on comparing these variables. On the other hand the mean time required for the harvest of iliac graft and mandible graft was 30.2 ± 3.52 min and 16.8 ± 1.75 min respectively. The difference was statistically significant. CONCLUSION There is no difference in the ability of mandible and anterior iliac crest bone grafts to correct post-traumatic diplopia, enophthalmos and restricted ocular movements. But the time and ease of harvest of the graft from mandible was comparatively less and easy especially when the treating doctor was an oral and maxillofacial surgeon. Secondly the post-operative morbidity was low and the quality and contour of the bone graft was very adaptable for the reconstruction of the orbital floor.
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Affiliation(s)
- Vipul Garg
- Department of Oral and Maxillofacial Surgery, Himachal Institute of Dental Sciences (HIDS), Paonta Sahib, Himachal Pradesh India
| | - Girish B Giraddi
- Department of Oral and Maxillofacial Surgery, Government Dental College and Research Institute, Bangalore Fort, Karnataka India
| | - Swati Roy
- Department of Oral and Maxillofacial Pathology, Himachal Institute of Dental Sciences (HIDS), Paonta Sahib, Himachal Pradesh India
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Moreno EFC, Vasconcelos BCDE, Carneiro SCDAS, Catunda IS, Melo AR. Evaluation of fixation techniques with titanium plates and Kirschner wires for zygoma fractures: preliminary study. J Oral Maxillofac Surg 2012; 70:2386-93. [PMID: 22884119 DOI: 10.1016/j.joms.2012.06.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/18/2012] [Accepted: 06/02/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the quality of treatment using two reduction and fixation techniques for zygoma fractures. PATIENTS AND METHODS A randomized clinical trial was carried out involving a sample of 10 patients with Knight and North type III, IV and V zygoma fractures divided into two groups. One group underwent the closed reduction technique and fixation with Kirschner wire and the other group underwent the open reduction technique and fixation with titanium plates. The groups were submitted to subjective evaluation based on the patient's perception of areas of deformity and paresthesia as well as the measurement of range of mouth opening and pain upon mouth opening in the preoperative (T0) and postoperative (T1) periods. The assessment of bone reduction quality was performed using quantifiable points (lateral wall of the orbit, anteroposterior projection of the zygoma and ocular globe projection), measured based on tomographic images. RESULTS Seventy percent of the patients remained with paresthesia and 20% remained with the complaint of deformity at T1. Mouth opening range increased in both groups at T1. In the overall sample, mean total disjunction of the lateral wall of the orbit and the difference in the anteroposterior projection of the zygoma were reduced between T0 and T1 (4.36 mm to 1.25 mm and 6.94 mm to 2.86 mm, respectively). There was also a reduction in ocular globe projection in both groups between T0 and T1. CONCLUSIONS Both techniques achieved adequate reduction of zygoma fractures in the postoperative period.
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Laure B, Petraud A, Sury F, Tranquart F, Goga D. Resistance of the sheep skull after a monocortical cranial graft harvest. J Craniomaxillofac Surg 2012; 40:261-5. [DOI: 10.1016/j.jcms.2011.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 01/06/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022] Open
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Zunz E, Blanc O, Leibovitch I. Traumatic orbital floor fractures: repair with autogenous bone grafts in a tertiary trauma center. J Oral Maxillofac Surg 2011; 70:584-92. [PMID: 21664743 DOI: 10.1016/j.joms.2011.02.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/08/2011] [Accepted: 02/08/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the outcome of autologous bone grafts in the reconstruction of orbital floor fractures. A retrospective interventional case series was performed at a tertiary trauma center. MATERIALS AND METHODS All patients with traumatic orbital floor fractures that had been reconstructed using calvarial or iliac autogenous bone grafts from August 2006 to January 2010 were included in the present study. The operations were performed by the same team of maxillofacial and oculoplastic surgeons. The patients were evaluated pre- and postoperatively for the presence of enophthalmus and diplopia. The surgical technique was tailored to best fit the patient's clinical characteristics, with attention to the cosmetic and functional outcomes and the preferred use of a sutureless transconjunctival technique, when applicable. The main outcome measures were residual enophthalmus, diplopia, and the complication rate. RESULTS A total of 16 patients (11 males and 5 females), with an average age of 34.4 years, underwent orbital floor reconstruction using an autologous bone graft. Calvarial and iliac bone grafts were used in 11 and 5 patients, respectively. A transconjunctival approach was applied in 10 patients. All patients achieved good cosmetic and functional outcomes, with improvement in enophthalmus. Three patients had residual diplopia postoperatively that was probably due to traumatic muscular injury. No significant perioperative or long-term complications were noted during a mean follow-up of 12.5 months. CONCLUSION Reconstruction of orbital floor fractures after trauma using autologous bone grafts is safe and associated with a low rate of complications. Combining the appropriate surgical approach with multidisciplinary teamwork results in excellent cosmetic and functional outcomes and allows for efficient and comprehensive postoperative management.
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Affiliation(s)
- Eran Zunz
- Division of Ophthalmic Plastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Sourasky Medical Centre, Tel-Aviv University, Tel-Aviv, Israel.
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Reoperative Orbital Trauma: Management of Posttraumatic Enophthalmos and Aberrant Eye Position. Oral Maxillofac Surg Clin North Am 2011; 23:17-29, v. [DOI: 10.1016/j.coms.2010.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tabrizi R, Ozkan TB, Mohammadinejad C, Minaee N. Orbital Floor Reconstruction. J Craniofac Surg 2010; 21:1142-6. [DOI: 10.1097/scs.0b013e3181e57241] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ram H, Singh RK, Mohammad S, Gupta AK. Efficacy of Iliac Crest vs. Medpor in Orbital Floor Reconstruction. J Maxillofac Oral Surg 2010; 9:134-41. [PMID: 22190772 PMCID: PMC3244104 DOI: 10.1007/s12663-010-0047-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022] Open
Abstract
AIM The present study is to compare the effectiveness of iliac crest graft and medpor implant, for repairing traumatic orbital floor defects. MATERIALS AND METHODS A total of 20 patients were included in the study. Autogenous iliac crest graft and medpor implant was used in 10 patients of the each group. Patients were evaluated for the presence or absence of diplopia, enophthalmos, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8 mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. RESULTS All patients were successfully treated by restoration of the orbital wall continuity. Follow-up was done at 1-12 weeks. One patient had postoperative infection. There was no graft extrusion. CONCLUSIONS Both the groups showed satisfactory results, but group II was better than group I, as there was no donor site morbidity. Porous polyethylene (Medpor) is a biocompatible and high-density polyethylene implant. It is well tolerated by surrounding tissue, and its porous structure is rapidly infiltrated by host tissue. It is a highly stable and somewhat flexible porous alloplast that has rapid tissue in growth into its pores.
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Affiliation(s)
- Hari Ram
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - R. K. Singh
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - Anup Kumar Gupta
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
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Abstract
Fractures of the medial orbital wall can be isolated or associated with other orbital defects arising from maxillofacial fractures. However, a medial orbital wall defect results in a relative increase of the orbital volume. The decision regarding surgical intervention in the management of medial orbital wall fractures is influenced by a variety of factors, including the presence and severity of restricted ocular motility, the degree of enophthalmos, the estimated fracture size, and the clinical judgment of the surgeon; however, untreated medial orbital wall fractures can result in secondary enophthalmos. The aim of this study was to describe our experience with deantigenated swine bone cortex for the reconstruction of the fractured medial orbital wall.
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Abstract
Enophthalmos is a relatively frequent and misdiagnosed clinical sign in orbital diseases. The knowledge of the different etiologies of enophthalmos and its adequate management are important, because in some cases, it could be the first sign revealing a life-threatening disease. This article provides a comprehensive review of the pathophysiology, evaluation, and management of enophthalmos. The main etiologies, such as trauma, chronic maxillary atelectasis (silent sinus syndrome), breast cancer metastasis, and orbital varix, will be discussed. Its objective is to enable the reader to recognize, assess, and treat the spectrum of disorders causing enophthalmos.
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Affiliation(s)
- Mehrad Hamedani
- Jules Gonin Eye Hospital--University of Lausanne, Lausanne, Switzerland
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Kontio RK, Laine P, Salo A, Paukku P, Lindqvist C, Suuronen R. Reconstruction of Internal Orbital Wall Fracture with Iliac Crest Free Bone Graft: Clinical, Computed Tomography, and Magnetic Resonance Imaging Follow-Up Study. Plast Reconstr Surg 2006; 118:1365-1374. [PMID: 17051107 DOI: 10.1097/01.prs.0000244519.26368.4c] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to clinically and radiologically assess the outcome of internal orbital reconstruction with an iliac bone graft. METHODS Twenty-four consecutive patients with unilateral orbital wall fractures were enrolled in this prospective study. A medial cortical wall from the anterior ilium was used for reconstruction. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and magnetic resonance imaging were used to observe graft posture, bone defects, and intraorbital soft-tissue changes. RESULTS Most fractures (46 percent) were pure orbital floor fractures. The mean follow-up was 7.8 months. One patient with medial wall and floor fractures required reoperation because of insufficient bone graft. At the last follow-up, this was the only patient (4 percent) with both enophthalmos (2 mm) and hypophthalmos (3 mm). Five patients (21 percent) had hypophthalmos (> 1 mm) at the end of the study. Resorption and remodeling were detected in all grafts, but no grafts were totally resorbed. Sagittal or coronal bone graft postures were assessed as good in 18 orbits (75 percent). Bone defects (> 10 mm) at reconstructed areas were detected in 13 orbits (54 percent). Scar tissue was observed only in three reconstructed orbits (13 percent). Diplopia in central field of vision was registered in seven patients preoperatively but in none at the end of the study. CONCLUSIONS The resorption rate was high, but most of it was advantageous remodeling. Overall outcome was good. Secondary operations led to poor outcomes. Thin computed tomography and magnetic resonance imaging sections (< or = 2 mm) are needed to evaluate accurately bone graft placement and posture and orbital volume.
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Affiliation(s)
- Risto K Kontio
- Helsinki, Finland From the Departments of Oral and Maxillofacial Surgery and Radiology, Helsinki University Central Hospital, and Department of Oral and Maxillofacial Surgery, Helsinki University
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Al-Sukhun J, Lindqvist C. A Comparative Study of 2 Implants Used to Repair Inferior Orbital Wall Bony Defects: Autogenous Bone Graft Versus Bioresorbable Poly-L/DL-Lactide [P(L/DL)LA 70/30] Plate. J Oral Maxillofac Surg 2006; 64:1038-48. [PMID: 16781336 DOI: 10.1016/j.joms.2006.03.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare our clinical findings on the use of autogenous bone grafts and bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] implants to repair inferior orbital wall defects. PATIENTS AND METHODS Thirty-nine patients who suffered orbital blow-out fractures with >or=2 cm2 bony defect in the inferior orbital wall took part in the study. Each inferior orbital wall was reconstructed using either an autogenous bone graft or a triangle form plate of P(L/DL)LA 70/30. Computed tomography scans were taken before the operation and at 2 and 36 weeks postoperatively. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, numbness, gaze restrictions, size of bony defect after treatment, bone growth, and implant resorption. A comparative study was carried out using chi2 test and the Fisher exact test. We considered P < .05 to be statistically significant. RESULTS The clinical outcome was excellent in 19 of the 24 (79%) cases treated with autogenous bone grafts and in 13 of the 15 (87%) cases treated with P(L/DL)LA 70/30. No statistically significant differences were found between the 2 groups in overall type or number of complications. The most frequent type of complication found in both groups was enophthalmos, with 5 cases (bone graft, 3; P(L/DL)LA plates, 2). Diplopia was the second most frequent type of complication; however, both complications caused no need for the removal of the implants in either group. CONCLUSION Autogenous bone grafts and P(L/DL)LA 70/30 implant plates do not present statistically significant differences in the parameters studied. Taking into account the availability and the advantages of P(L/DL)LA 70/30 implants when compared with autogenous bone grafts, our results allow us to conclude that there is no compromise regarding successful bridging of orbital floor defects using biodegradable P(L/DL)LA 70/30 osteosyntheses.
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Affiliation(s)
- Jehad Al-Sukhun
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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Kontio R. Treatment of orbital fractures: the case for reconstruction with autogenous bone. J Oral Maxillofac Surg 2004; 62:863-8. [PMID: 15218567 DOI: 10.1016/j.joms.2004.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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Enislidis G. Treatment of orbital fractures: the case for treatment with resorbable materials. J Oral Maxillofac Surg 2004; 62:869-72. [PMID: 15218568 DOI: 10.1016/j.joms.2003.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Georg Enislidis
- University-Clinic for Oral and Maxillofacial Surgery, General Hospital Vienna, Vienna, Austria.
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