Application of One Piece Autologous Rib Cartilage Graft in Hollow Space of Complete Naso-Ethmoid Orbital Fracture

Abstract

Background: Complete naso-orbital-ethmoid (NOE) complex fractures including hollow space defects are difficult to treat. A proper bone fragment should be maintained for bony rearrangement and reconstruction; however, no guidelines are available for the treatment of the NOE complex. In patients with empty bone fragment from NOE fractures, implantation of autologous rib grafts may be an option for recreating the orbital rim. Methods: A 57-year-old man with open complete NOE fracture. Computed tomography (CT) revealed complete loss of bone fragments within the NOE area, including the inferior orbital rim and maxillary wall. A bone was harvested from the right fifth rib. The grafted bone mimicked the inferomedial orbital rim and was stabilized with mid plates. Results: Follow-up CT and three-dimensional (3D) volumetry were performed at 1, 3, 6, and 12 months. A well-positioned rib graft and orbital wall were observed. In 3D volumetry analysis, we noted that the absorption rate of the rib cartilage was 7.84% at 6 months. The absorption rate of rib cartilage was evaluated using CT images, which were reconstructed with a 3D image reconstruction program (-VIEW, Coreline soft, Seoul, Korea). Conclusions: Complete NOE fractures, especially fractures involving loss of the buttress for plating, may pose a burden to surgeons. In such cases, implantation of an autologous rib cartilage graft is a good option for bony frame reconstruction, without any concerns of bony resorption.