Orbital floor fracture reconstruction using autologous bone graft: its outcome, advantages and disadvantages
DOI:
https://doi.org/10.18203/2349-2902.isj20252284Keywords:
Orbital floor fracture, Iliac crest bone graft, Orbital reconstruction, Autologous bone graft, Enophthalmos, Diplopia, Orbital volume restoration, Muscle entrapmentAbstract
Orbital floor fractures are commonly encountered facial injuries requiring precise reconstruction to restore orbital volume and prevent functional and cosmetic sequelae. This retrospective study evaluated the outcomes, advantages, and disadvantages of orbital floor reconstruction using autologous iliac crest bone grafts in 20 patients aged 18 to 60 years, all presenting with unilateral orbital floor fractures involving more than 50% of the floor or associated with diplopia or extraocular muscle entrapment. All patients underwent reconstruction within 14 days of injury. Pre- and postoperative assessments included computed tomography (CT)-based orbital volume calculations, anteroposterior globe positioning, and clinical evaluations of diplopia, infraorbital nerve function, and ocular motility. The mean preoperative orbital volume difference between the fractured and contralateral sides was significantly reduced from 5.1 cm3 to 0.2 cm3 postoperatively (p<0.001), with correction of enophthalmos achieved in 90% of cases. Diplopia resolved in 6 of 7 patients postoperatively, and infraorbital nerve hypoesthesia showed improvement in the majority. No cases of graft resorption were observed on follow-up imaging, and only one patient experienced mild, self-limiting donor site morbidity. These outcomes demonstrate that iliac crest bone grafting is a reliable and biocompatible option for orbital floor reconstruction, offering excellent anatomical and functional restoration without the complications associated with alloplastic materials. Compared to titanium mesh, previously shown to provide good radiological and clinical results, iliac bone grafts offer the added advantage of biological integration. Given its favourable safety and efficacy profile, iliac crest bone remains a valuable material for complex orbital floor reconstruction.
Metrics
References
Hwang K, You SH. Analysis of orbital bone fractures: A 12-year study of 391 patients. J Craniofac Surg. 2010;21(4):1218-21. DOI: https://doi.org/10.1097/SCS.0b013e3181acde01
Converse JM, Smith B, Obear MF, Wood-Smith D. Orbital blow-out fractures: a ten-year survey. Plast Reconstr Surg. 1967;39(1):20-36. DOI: https://doi.org/10.1097/00006534-196701000-00002
Burnstine MA. Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis. Ophthalmology. 2002;109(7):1207-10. DOI: https://doi.org/10.1016/S0161-6420(02)01057-6
Tabrizi R, Ozkan BT, Mohammadinejad C, Aydin ME. Evaluation of blow-out fractures of the orbital floor. J Craniofac Surg. 2010;21(4):1161-3. DOI: https://doi.org/10.1097/SCS.0b013e3181e57241
Zimmerer RM, Schneider M, Kreutzer K, et al. A prospective multicenter study on titanium mesh or autologous bone reconstruction of the orbital floor. J Craniomaxillofac Surg. 2016;44(5):629-35.
Kwon JH, Oh TS, Choi HY, et al. Clinical outcomes of orbital wall reconstruction using synthetic versus autologous materials. Arch Plast Surg. 2014;41(6):764-71.
Piombino P, Dell’Aversana Orabona G, Greco L, et al. Orbital floor reconstruction using iliac crest graft: A long-term follow-up. J Craniofac Surg. 2020;31(5):1293-7.
Kainulainen V, Kontio R, Laine P, Lindqvist C. Use of iliac crest bone grafts in reconstruction of orbital floor. Scand J Surg. 2005;94(2):161-5.
Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma. 1989;3(3):192-5. DOI: https://doi.org/10.1097/00005131-198909000-00002
Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;(329):300-9. DOI: https://doi.org/10.1097/00003086-199608000-00037
Burm JS, Oh SJ. A retrospective analysis of the cause, treatment, and prognosis of enophthalmos. Plast Reconstr Surg. 1998;101(4):959-65.
Ellis E, Tan Y. Assessment of internal orbital reconstructions for pure blowout fractures: Cranial bone grafts versus titanium mesh. J Oral Maxillofac Surg. 2003;61(4):442-53. DOI: https://doi.org/10.1053/joms.2003.50085
Nagasao T, Miyamoto J, Shimizu Y. The effect of differences in orbital volume on enophthalmos in orbital fracture. Plast Reconstr Surg. 2006;117(7):1962-9.
Kontio R, Laine P, Salo A, Suuronen R. Management of orbital blow-out fractures with polydioxanone implant. J Oral Maxillofac Surg. 2001;59(12):1390-5.
Shields JA, Shields CL. Orbital fracture repair using alloplastic materials. Curr Opin Ophthalmol. 2000;11(5):289-94.
Manson PN, Markowitz B, Mirvis SE. Toward CT-based facial fracture treatment. Plast Reconstr Surg. 1990;85(2):202-12. DOI: https://doi.org/10.1097/00006534-199002000-00006
Yaremchuk MJ. Facial skeletal reconstruction using composite alloplastic implants. Plast Reconstr Surg. 2003;111(6):1818-27. DOI: https://doi.org/10.1097/01.PRS.0000056866.80665.7A
Zingg M, Laedrach K, Chen J, Chowdhury K, Vuillemin T, Sutter F, et al. Classification and treatment of zygomatic fractures: A review of 1,025 cases. J Oral Maxillofac Surg. 1992;50(8):778-90. DOI: https://doi.org/10.1016/0278-2391(92)90266-3
Tessier P, Kawamoto H, Posnick J, Raulo Y, Tulasne JF, Wolfe SA. Complications of harvesting autogenous bone grafts. Plast Reconstr Surg. 2005;116(5):72S-3S. DOI: https://doi.org/10.1097/01.prs.0000173841.59063.7e
Kim YH, Park JH, Lee JI. Long-term results after reconstruction of orbital floor with autogenous iliac bone graft. J Craniofac Surg. 2014;25(4):1295-9.
Alinasab B, Rasten-Almqvist P, Thorén H. Long-term follow-up of autologous bone grafts for orbital floor reconstruction. J Plast Surg Hand Surg. 2019;53(5):286-90.
Shah K, Thakurani S. Assessing the adequacy of orbital reconstruction with titanium mesh using clinical and radiological measures. Cureus. 2024;16(9):70324. DOI: https://doi.org/10.7759/cureus.70324