Reconstruction of Orbital Floor Fracture Using Solvent-Preserved Bone Graft

Abstract

The orbital floor is one of the most frequently damaged parts of the maxillofacial skeleton during facial trauma. Unfavorable aesthetic and functional outcomes are frequent when it is treated inadequately. The treatment consists of spanning the floor defect with a material that can provide structural support and restore the orbital volume. This material should also be biocompatible with the surrounding tissues and easily reshaped to fit the orbital floor. Although various autografts or synthetic materials have been used, there is still no consensus on the ideal reconstruction method of orbital floor defects. This study evaluated the applicability of solvent-preserved cadaveric cranial bone graft and its preliminary results in the reconstruction of the orbital floor fractures. Twenty-five orbital floor fractures of 21 patients who underwent surgical repair with cadaveric bone graft during a 2-year period were included in this study. Pure blowout fractures were determined in nine patients, whereas 12 patients had other accompanying maxillofacial fractures. Of the 21 patients, 14 had clinically evident diplopia (66.7 percent), 12 of them had enophthalmos (57.1 percent), and two of them had gaze restriction preoperatively. Reconstruction of the floor of the orbit was performed following either the subciliary or the transconjunctival approach. A cranial allograft was placed over the defect after sufficient exposure. The mean follow-up period was 9 months. Postoperative diplopia, enophthalmos, eye motility, cosmetic appearance, and complications were documented. None of the patients had any evidence of diplopia, limited eye movement, inflammatory reactions in soft tissues, infection, or graft extrusion in the postoperative period. Providing sufficient orbital volume, no graft resorption was detected in computed tomography scan controls. None of the implants required removal for any reason. Enophthalmos was seen in one patient, and temporary scleral show lasting up to 3 to 6 weeks was detected in another three patients. Satisfactory cosmetic results were obtained in all patients. This study showed that solvent-preserved bone, which is a nonsynthetic, human-originated, processed bioimplant, can be safely used in orbital floor repair and can be considered as another reliable treatment alternative.

Analysis of the orbital floor morphology

“…Maxillofacial, ENT and plastic surgeons sometimes encounter clinical cases where orbital floors are destroyed by fractures (Bartkowski and Krzystkowa, 1982;Hayasaka et al, 1994;Schubert et al, 2002;Hughes et al, 2003;Kosaka et al, 2004;Lynham et al, 2004;Yavuzer et al, 2004;Buchel et al, 2005;Eppley, 2005) or are removed in advanced tumours (Cordeiro et al, 1998;Lee et al, 1999;Holmes and Hutchinson, 2001;Parmar et al, 2001). For these, the defects of the orbital floor have to be repaired to match its original shape as closely as possible.…”

Comparison of Efficacy of Mandible and Iliac Bone as Autogenous Bone Graft for Orbital Floor Reconstruction

“…Recently, progress in biomaterial science has provided another option: bioabsorbable materials that consist of mainly poly-L-lactic acid and polyglycolic acid, which are absorbed slowly and simultaneously replaced by tissues. Although these materials might be adequate for small defects of the orbital floor, they are not suitable for volume-demanding defects [1,[10][11][12]. Inspite of substantial progress in the biomaterial science, autogenous bone remains the gold standard in maxillofacial reconstructive surgery.…”

“…This material should also be biocompatible with the surrounding tissues and easily reshaped to fit the orbital floor. Although various autografts or synthetic materials have been used, there is still no consensus on the ideal reconstruction method of orbital floor defects [1].…”

Clinical management and reconstruction of isolated orbital floor fractures: The role of computed tomography during preoperative evaluation

“…[5,18] Various materials are used in reconstruction of the orbital floor, such as autogenic grafts (bone, cartilage, fascia, etc. ), [26][27][28][29][30][31] allogenic grafts, [32,33] and alloplastic materials (silicone, polytetrafluoroethylene, hydroxylapatite, porous polyethylene, titanium, and Vitallium mesh). [34][35][36][37][38][39][40][41] There are studies outlining their advantages, disadvantages and success rates.…”