Correction of post-traumatic enophthalmos with anatomical absorbable implant and iliac bone graft

Abstract

Background: Trauma is one of the most common causes of enophthalmos, and post-traumatic enophthalmos primarily results from an increased volume of the bony orbit. We achieved good long-term results by simultaneously using an anatomical absorbable implant and iliac bone graft to correct post-traumatic enophthalmos. Methods: From January 2012 to December 2016, we performed operations on seven patients with post-traumatic enophthalmos. In all seven cases, reduction surgery for the initial trauma was performed at our hospital. Hertel exophthalmometry, clinical photography, three-dimensional computed tomography (3D-CT), and orbital volume measurements using software to calculate the specific volume captured on 3D-CT (ITK-SNAP, Insight Toolkit-SNAP) were performed preoperatively and postoperatively. Results: Patients were evaluated based on exophthalmometry, clinical photographs, 3D-CT, and orbital volume measured by the ITK-SNAP program at 5 days and 1 year postoperatively, and all factors improved significantly compared with the preoperative baseline. Complications such as hematoma or extraocular muscle limitation were absent, and the corrected orbital volume was well maintained at the 1-year follow-up visit. Conclusion: We present a method to correct enophthalmos by reconstructing the orbital wall using an anatomical absorbable implant and a simultaneous autologous iliac bone graft. All cases showed satisfactory results for enophthalmos correction. We suggest this method as a good option for the correction of post-traumatic enophthalmos.

Comparison of post-operative outcomes of graft materials used in reconstruction of blow-out fractures

“…Many authors recommended the use of different synthetic and autogenous biomaterials, each with its advantages and disadvantages, for the reconstruction of orbital floor defects. [4,[11][12][13][14] In the past, there was a common belief that bone grafts were the most appropriate implant materials for orbital floor reconstruction. [4,5,7] Autogenous bone grafts have been recommended under their ability to provide a more sustained and stable reconstruction.…”

“…[13,15] The iliac bone grafts used in our study to reconstruct the orbital floor; however, they have some disadvantages, including the long time required for dissection, the risk of hematoma and pain at the donor area, and more prominent resorption in the graft due to its enchondral origin. [4,13,16] Besides, it is difficult to shape the bone tissue to fit the contour of the orbital floor because of the rigidity.…”

“…Two to three millimeters of enophthalmos is clinically detectable, and more than 5mm is disfiguring. [4] Although there is not any strict consensus on the indications for surgical repair of orbital floor fractures, mechanical muscle compression causing diplopia is one of the surgical indications. This situation can be identified using the forced duction test or imaging techniques.…”

“…Many surgeons believe that defects more significant than 1 cm² require surgery as they cause enophthalmos. [4] Many conventional strategies have been used to correct posttraumatic enophthalmos. Many autogenous and alloplastic biomaterials have been recommended to correct bony orbit, such as autogenous bone grafts, cartilage grafts, fascia grafts and artificial prostheses (using absorbable or nonabsorbable materials).…”

“…Also, it should not induce a foreign body reaction or create a medium for the growth of microorganisms. [4,[9][10][11] To allow radiographic evaluation, radio-opaque materials that do not form any artifacts are preferred. The main problems due to the use of these materials are infection and extrusion risks.…”