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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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Antral Wall Approach for Reconstruction of Orbital Floor Fractures Using Anterior Maxillary Sinus Bone Grafts. J Craniofac Surg 2018. [DOI: 10.1097/scs.0000000000004454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Reininger D, Cobo-Vázquez C, Rosenberg B, López-Quiles J. Alternative intraoral donor sites to the chin and mandibular body-ramus. J Clin Exp Dent 2017; 9:e1474-e1481. [PMID: 29410765 PMCID: PMC5794127 DOI: 10.4317/jced.54372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/23/2017] [Indexed: 11/05/2022] Open
Abstract
Background Provide a review of alternative intraoral donor sites to the chin and body-ramus of the mandible that bring fewer complications and that may be used to regenerate small and medium defects. Material and Methods A review was conducted using the search engine PUBMED and looking manually into scientific journals. Results From the 35 articles included, 6 corresponded to the coronoids, 3 corresponded to the zygomatic body, 5 corresponded to the anterior maxillary sinus wall, 3 corresponded to the zygomatic alveolar process, 2 corresponded to the incisive fossa, 2 corresponded to the anterior nasal spine, 2 corresponded to the palatal region, 5 corresponded to the tuberosity, and 7 corresponded to the palatal and mandibular tori. Conclusions Although there are few complications described when using alternative intraoral donor sites, the main problem with these types of grafts is their scarce bone volume, with only the zygomatic body, anterior sinus wall, and palate sites being able to be used in medium defects. More clinical trials are necessary in order to evaluate the behavior of the alternative donor sites over time. Key words:Grafting, autologous bone, autografts, mandible, maxilla, palate hard, zygoma.
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Affiliation(s)
- David Reininger
- DDS, Master in Oral Surgery and Implantology. Instructor Professor, Departament of Oral and Maxillofacial Surgery, Universidad de los Andes
| | - Carlos Cobo-Vázquez
- PhD, DDS, Master in Oral Surgery and Implantology, Universidad Complutense de Madrid
| | | | - Juan López-Quiles
- DDS, MD, PhD, Maxillofacial Surgeon, Associate Professor, Department of Oral Surgery and Maxillofacial Surgery, Universidad Complutense de Madrid
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Evaluation of the Retro-Orbital Fatty Tissue Volume in Delayed Orbital Blow-Out Fractures. Ophthalmic Plast Reconstr Surg 2017; 32:207-10. [PMID: 25951353 DOI: 10.1097/iop.0000000000000467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE In patients where diplopia and enophthalmia are manifest, surgical intervention is usually necessary. The pathogenesis of these symptoms usually includes the prolapse of orbital tissues into the sinus or compression by the surrounding bone structures. Although the retro-orbital fatty tissue, orbital fascia, and the muscle tissue can be reduced to the original place after being incarcerated into the maxillary space, it is obvious that the procedure can lead to significant fibrosis in these structures. The authors have aimed to carry out a quantitative evaluation of the fatty tissue volumes in patients with repair delayed for more than two weeks. METHODS The preoperative and postoperative fatty tissue volumes and the changes in total orbital volume were evaluated by using CT on the patients (n = 9) who were consulted to the authors' clinic from other health centers. RESULTS Although no significant correlation was observed between the prolapsed volume and the postoperative reduction in the fatty tissue, the reduction in the retro-orbital fatty tissue was statistically significant. CONCLUSION Evaluating postoperative retro-orbital fatty tissue volumes may have implications for surgical intervention in the future.
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Transmaxillary Sinus Approach for Le Fort II Osteotomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e619. [PMID: 27014548 PMCID: PMC4778890 DOI: 10.1097/gox.0000000000000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022]
Abstract
The Le Fort II osteotomy is a relatively rare operation. The posterior wall osteotomy of the maxillary sinus (MS) is often difficult for Le Fort III. We developed the transmaxillary sinus approach (TSA) for the Le Fort II osteotomy that cuts the posterior wall of the MS directly. This report illustrates this easy-to-use procedure for the Le Fort II osteotomy in syndromic craniosynostosis. This procedure was performed in an 18-year-old patient with Apert syndrome and a 15-year-old patient with Pfeiffer syndrome. The thin anterior walls of the MS were removed through an intraoral approach to look inside the MS. Then, the posterior walls were cut by chisel under direct vision using light. The other osteotomy was performed as usual. Distraction osteogenesis with internal and external devices was used in combination. The advantages of TSA are the direct posterior wall osteotomy of the MS with no down fracture and minimal invasiveness to the mucosa of the MS under direct vision. However, the disadvantage is that TSA becomes a blind procedure in a case with no MS or hypoplasia. We developed the TSA for the Le Fort II osteotomy, which could provide direct observation and perform the posterior wall osteotomy of the MS without down fracture. We believe that TSA is an effective surgical procedure for the Le Fort II osteotomy.
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O TM, Richard MJ, Cullinane DM, Binetter DJ, Fay A, Der Sarkissian R. A Biomechanical Evaluation of Auricular Cartilage Autografts in Orbital Floor Defect Repair. Orbit 2015; 34:121-6. [PMID: 25905861 DOI: 10.3109/01676830.2015.1014504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Auricular cartilage is used as a surgical implant in the management of orbital floor fractures. However, no specific parameters exist regarding the use/limitations of this potential graft. In order to determine the mechanical efficacy of adult auricular cartilage grafts, a mechanical model was developed and studied for structural threshold size limits. METHODS Thirty-seven cadaveric auricular cartilage specimens were tested in a laboratory. A plexiglass baseplate was created with four different sized holes, defined as 1.0×, 1.2×, 1.4×, and 1.6× the mean minor axis of the specimens. Each specimen was used to bridge one hole under increasing loads until mechanical failure. Structural stiffness at three different loading stages, structural failure strength, and percent failure of the entire system for each defect size was calculated. RESULTS Specimens tested on 1.0×, 1.2×, 1.4× and 1.6× defects demonstrated 0%, 0%, 20%, and 60% system failure rates, respectively. Structural stiffness curves showed a similar trend, with ANOVA demonstrating a significant difference in mechanical properties between defect sizes (p = 0.03). The curve representing 1.6 × defect size demonstrated significantly reduced structural stiffness relative to 1.0×, 1.2×, and 1.4× curves. There was no statistical difference between 1.2× and 1.4× testing sets (p = 0.09). CONCLUSION A clinically significant biomechanical and functional threshold exists between 1.2×and 1.4× defect sizes. Given a mean minor axis of 2.06 cm, orbital blow-out defects <2.4 cm (1.2 × 2.06 cm) are suitable for auricular cartilage grafts; fractures >2.4 cm may require a more rigid material. Cartilage grafts that allow failure, however, may better protect the globe in subsequent injury.
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Affiliation(s)
- Teresa M O
- Department of Otolaryngology, Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, North Shore LIJ Health System , New York, New York , USA
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Bielecki T, Wójcik K, Bold T, Osadnik B, Szczepański T. The Influence of Leukocyte and Platelet Concentrate Enrich in Stem Cells on Bone Regeneration Processes: A Clinical and Flow Cytometry Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jbise.2015.89062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bande CR, Daware S, Lambade P, Patle B. Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study. J Maxillofac Oral Surg 2014. [PMID: 26225051 DOI: 10.1007/s12663-014-0716-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. MATERIAL AND METHODS Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. CONCLUSION The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.
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Affiliation(s)
- Chandrashekhar R Bande
- Department of Oral and Maxillo-facial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
| | - Surendra Daware
- Department of Oral and Maxillo-facial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
| | - Pravin Lambade
- Department of Oral and Maxillo-facial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
| | - Bhaskar Patle
- Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
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Gunarajah DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg 2013; 71:550-70. [PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/10/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults. MATERIALS AND METHODS A systematic search of the English literature was performed in the databases of PubMed, Cochrane Library, and EMBASE. The study selection process was adapted from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, and 55 articles complied with the study inclusion criteria. The primary outcome measures were diplopia, enophthalmos, graft extrusion/displacement, and infection related to the graft material. The secondary outcome measures were infraorbital paresthesia, orbital dystopia, orbital soft tissue entrapment, and donor-site complications. RESULTS Of 55 articles, 41 (74.5%) evaluated were retrospective case series, 9 (16.4%) were retrospective case-control studies, 3 (5.5%) were controlled trials, and 2 (3.6%) were prospective case series. Autogenous graft materials were predominantly used in 19 studies, alloplastic materials were used in 33 studies, and the remaining 3 articles reported on allogeneic materials. Overall, 19 different types of implant materials were used in 2,483 patients. Of 827 patients with diplopia before surgery, 151 (18.3%) had diplopia postoperatively. Of 449 patients with enophthalmos before surgery, 134 (29.8%) had enophthalmos postoperatively. Only 2 patients (0.1%) and 14 patients (0.6%) had graft extrusion/displacement and infection related to the graft material, respectively; alloplastic biomaterials were used in all of these cases. CONCLUSIONS All graft materials used were successful to variable degrees because all studies reported improvement in terms of the recorded outcome measures. A guideline for choice of implant material based on defect size was developed.
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Orbital floor reconstruction in zygomatic-orbital-maxillary fracture with a fractured maxillary sinus wall segment as useful bone graft material. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2013. [DOI: 10.1016/j.ajoms.2011.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Biomaterials and implants for orbital floor repair. Acta Biomater 2011; 7:3248-66. [PMID: 21651997 DOI: 10.1016/j.actbio.2011.05.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/19/2011] [Accepted: 05/16/2011] [Indexed: 11/23/2022]
Abstract
Treatment of orbital floor fractures and defects is often a complex issue. Repair of these injuries essentially aims to restore the continuity of the orbital floor and to provide an adequate support to the orbital content. Several materials and implants have been proposed over the years for orbital floor reconstruction, in the hope of achieving the best clinical outcome for the patient. Autografts have been traditionally considered as the "gold standard" choice due to the absence of an adverse immunological response, but they are available in limited amounts and carry the need for extra surgery. In order to overcome the drawbacks related to autografts, researchers' and surgeons' attention has been progressively attracted by alloplastic materials, which can be commercially produced and easily tailored to fit a wide range of specific clinical needs. In this review the advantages and limitations of the various biomaterials proposed and tested for orbital floor repair are critically examined and discussed. Criteria and guidelines for optimal material/implant choice, as well as future research directions, are also presented, in an attempt to understand whether an ideal biomaterial already exists or a truly functional implant will eventually materialise in the next few years.
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