In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

Uemura, Tetsuji; Yanai, Tetsu; Yasuta, Masato; Harada, Yoshimi; Morikawa, Aya; Watanabe, Hidetaka; Kurokawa, Mineo

doi:10.1055/s-0036-1597915

Cited by 3 publications

(3 citation statements)

References 14 publications

(29 reference statements)

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“…12 Since then, the use of rib graft for orbital reconstruction has been explored in isolated studies in the adult population. Uemura et al 13 published a study of 22 adult patients elaborating on the insite split rib graft technique for orbital floor and medial wall reconstruction. Lee et al 14 also presented a series of nine adults patients with enophthalmos (seven posttraumatic and two post tumor resection) who underwent correction with rib bone segment and diced cartilage.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Niklinska

Pontell

Jaeger

et al. 2021

FACE

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Background: Orbital floor fractures constitute roughly 20% of all pediatric facial fractures. Reconstructive techniques are broadly subdivided into alloplastic and autologous. While pediatric literature exists for alloplastic orbital reconstruction, autologous orbital reconstruction studies are limited. Here we present several cases of posttraumatic pediatric orbital reconstruction utilizing autologous split rib graft. Methods: After IRB approval, a retrospective chart review was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt from 2003 to 2019. A review of relevant published literature was also performed. Results: From 2003 to 2019, 5 pediatric patients underwent orbital reconstruction with split rib graft. Of the 5 patients, 3 were female and 2 were male with an age range of 4 to 8 years old (mean 4.8). Two patients had isolated orbital blow-out fractures while 3 presented with concurrent midfacial fractures. In each patient, the orbit was reconstructed by contoured split rib corticocancellous graft. Average length of stay was 5.2 days. There were no postoperative pneumothoraces. Mean follow-up length was 18.7 months, with no rib donor site complications. Each patient had adequate orbital volume restoration with no postoperative globe malposition or persistent diplopia. Conclusion: Pediatric orbital fractures are complex and challenging injuries. While alloplastic reconstruction is common and reliable, the risks of foreign body implantation and fixation must be carefully considered in patients who have not yet reached skeletal maturity. This is especially pertinent in younger patients as orbital growth continues until approximately 9 years of age. Rib graft use for adult orbital reconstruction has been explored. Data in the pediatric literature has not been identified. Corticocancellous rib graft harvest mandates a second surgical site; however, it is relatively inconspicuous with low postoperative morbidity. Corticocancellous rib grafting is a safe and durable option for orbital reconstruction and should be considered for use in the pediatric patient with a growing facial skeleton.

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Section: Discussionmentioning

confidence: 99%

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Niklinska

Pontell

Jaeger

et al. 2021

FACE

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“…Although undeniable progress in the management of orbital floor fractures has occurred over the past decades, there is still a lack of broad consensus as to which material(s) should be used to restore proper anatomy of the orbital floor in order to achieve best clinical results. This is also reflected by the still very high number of recent studies describing various approaches and materials to reconstruct the orbital floor, such as titanium meshes [27], partially absorbable meshes [28], bioresorbable implants [29,30], resorbable collagen membranes [31], polydioxanone foils [32], porous polyethylene sheets [33], bioactive glass S53P4 implants [34], auricular conchal grafts [35], rib bone grafts [36], or heterologous cortical bone [37].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome Following Surgical Repair of Small Versus Large Orbital Floor Fractures Using Polyglactin 910/Polydioxanone (Ethisorb®)

et al. 2020

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The aim of this retrospective study was to evaluate the clinical outcome of surgical management of small versus large, isolated orbital floor fractures (OFFs) using polyglactin 910/polydioxanone (Ethisorb®). Covering a four-year period (2010–2013), all records concerning midfacial fractures with involvement of the orbit were screened. Isolated fractures of the orbital floor as well as combined injuries of the orbital floor and medial wall that had been treated surgically using polyglactin 910/polydioxanone (Ethisorb®) were included. Patients underwent a preoperative, a postoperative, and a late ophthalmologic assessment. The clinical outcomes of surgically managed small OFFs up to 2 cm2 were statistically analyzed and compared to clinical results in larger defects. The final sample included 61 patients (25 women, 36 men). Fractures up to 2 cm2 were found in 33 patients (54.1%), whereas 28 patients (45.9%) suffered from OFFs larger than 2 cm2. The clinical outcomes did not significantly differ between both sample categories, and statistical analysis showed a power of 0.91 to detect a potentially existing difference. On final examination, 52 patients were free of any clinical symptoms, whereas minor issues were found in seven subjects, and two patients suffered from severe impairment. In conclusion, polyglactin 910/polydioxanone (Ethisorb®) seems to be a suitable material for surgical repair of both small and large OFFs.

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“…Reports of using free rib graft to reconstruct the medial and orbital floor also exist [58]. A study by Tetsuji et al demonstrateed no significant complications after in an 8 week cohort [59].…”

Section: Costochondral Graftmentioning

confidence: 99%

Commonly Utilized Non Vascularised Bone Grafts in Maxillofacial Reconstruction

Anand¹,

Panwar²

2021

Surgical Management of Head and Neck Pathologies

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Surgical defects created secondary to oncological resection are often debilitating for patients, both functionally and esthetically. Meticulous surgical planning and intricate knowledge of the vital anatomical structures are essential for understanding the biology of reconstruction in the craniofacial skeleton. Unlike reconstructive procedures in other areas where the functional components may be given priority, reconstruction of the face requires a delicate balance between the esthetic and functional units. Despite new developments, autogenous grafts have frequently remained a reliable alternative that withstood the test of time. Non-vascularized bone grafts are often a subset of autogenous grafts, where the graft solely depends on the recipient’s vascularity and is indicated in defect sizes of less than 6 cm.

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In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

Cited by 3 publications

References 14 publications

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Clinical Outcome Following Surgical Repair of Small Versus Large Orbital Floor Fractures Using Polyglactin 910/Polydioxanone (Ethisorb®)

Commonly Utilized Non Vascularised Bone Grafts in Maxillofacial Reconstruction

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