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Cung TD, Hu S, Govindaraj S, Elahi E. Preservation of Infraorbital Nerve in Orbital Floor and Maxillary Defect Reconstruction With Patient-Specific Three-Dimensional Implant: A Case Report. Ophthalmic Plast Reconstr Surg 2022; 38:e136-e141. [PMID: 35550485 DOI: 10.1097/iop.0000000000002180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reconstruction of orbitomaxillary defects poses many operative challenges because it requires consideration of cosmetic as well as functional elements: reestablishing facial symmetry while constituting the orbital volume and preserving involved neurovascular structures. The development of patient-specific polyetheretherketone implants have revolutionized complex craniofacial reconstruction due to its adaptability to anatomic constraints and accommodation of vital structures. Herein, we described 2 cases of orbitomaxillary reconstruction using PEEK implant with novel modifications to preserve the infraorbital nerve with optimal cosmetic outcomes and minimal postoperative morbidity.
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Affiliation(s)
- Thai-Duong Cung
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirley Hu
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ebby Elahi
- Department of Ophthalmology, Department of Otolaryngology-Head and Neck Surgery, Division of Ophthalmic and Oculofacial Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Gengler I, Hsieh TY. Secondary Correction of Posttraumatic Enophthalmos. Facial Plast Surg 2022; 38:364-374. [PMID: 35545118 DOI: 10.1055/a-1849-5491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Posttraumatic enophthalmos (PE) arises when the ocular globe is displaced posteriorly and inferiorly in the orbital cavity due to a mismatch in orbital volume and orbital content. This most commonly happens after orbital fractures. The resulting disruptions to aesthetic form and ocular functions often necessitate surgical correction for reconstruction and restoration. The purpose of surgical management of PE is to reconstruct orbital shape and volume as well as to restore any herniated orbital content. This can be particularly challenging in cases involving large defects that require complex orbital reconstruction. Recent advancements in computer-aided surgery have introduced innovative and important tools to assist surgeons with these difficult cases. The ability to create customized, patient-specific implants can facilitate reconstruction involving complicated anatomy. Additionally, intraoperative imaging and intraoperative navigation can serve as useful guides for surgeons to more accurately place implants, especially in cases with limited visualization, in order to achieve optimal outcomes.
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Affiliation(s)
- Isabelle Gengler
- Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Tsung-Yen Hsieh
- Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, United States
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MARCOS-ALONSO S, VILLAOSLADA-FUENTES R, MUÑOZ-HERRERA Á, BATUECAS-CALETRÍO Á, SANTA-CRUZ-RUÍZ S, MARTÍNEZ-CARRANZA RA. Cirugía del schwannoma vestibular. Factores predisponentes y predictores de parálisis facial. REVISTA ORL 2019. [DOI: 10.14201/orl.20152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Aral AM, Özmen S, Uygur S, Kaya B, Coskun N, Ömeroglu S, Kılıc K. Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model. Plast Surg (Oakv) 2017; 25:163-170. [PMID: 29026821 DOI: 10.1177/2292550317702370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models. OBJECTIVE Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model. METHODS Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6. RESULTS No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups. CONCLUSION Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects.
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Affiliation(s)
- Ali Mubin Aral
- Department of Plastic Surgery, Yenimahalle Research and Training Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Selahattin Özmen
- Department of Plastic Surgery, Koc University School of Medicine, İstanbul, Turkey
| | - Safak Uygur
- Department of Plastic Surgery, Koc University School of Medicine, İstanbul, Turkey
| | - Basar Kaya
- Department of Plastic Surgery, Ufuk University, Ankara, Turkey
| | - Neslihan Coskun
- Department of Histology/Embryology, Gazi University School of Medicine, Ankara, Turkey
| | - Suna Ömeroglu
- Department of Histology/Embryology, Gazi University School of Medicine, Ankara, Turkey
| | - Koray Kılıc
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
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Oya R, Shikina T, Takenaka Y, Uno A, Horii A, Inohara H. Endoscopic repair through the medial wall of maxillary sinus for blowout fracture of the inferior orbital wall: a case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1303605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ryohei Oya
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takashi Shikina
- Department of Otorhinolaryngology Head and Neck Surgery, Ikeda Municipal Hospital, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Arata Horii
- Department of Otorhinolaryngology Head and Neck Surgery, Niigata University Graduate School of Medicine and Dentistry, Niigata, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Turan A, Kostakoğlu N, Tuncel U, Gökçe E, Markoç F. Scapular Bone Grafts: Good Options for Craniofacial Defects? Ann Plast Surg 2017; 76:509-16. [PMID: 25255032 DOI: 10.1097/sap.0000000000000357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is still no consensus on the ideal material to be used in craniofacial defects. Autogenous bone grafts are mostly preferred owing to their use with fewer complications. The aim of this study was to evaluate whether the scapular bone graft can be used with equal or more advantages to other bone graft resources in orbital, maxillary sinus front wall, and frontal bone defects. PATIENTS AND METHODS Twenty-four orbital, maxillary sinus front wall, and frontal bone defects were reconstructed with scapular bone grafts. Sixteen patients presented with complicated orbital fractures, 5 patients presented with isolated orbital floor fractures, and 3 patients presented with frontal bone fractures. The grafts were radiologically evaluated 1 day, 6 months, and 12 months postoperatively by 3-dimensional computed tomography scan. RESULTS All orbital, maxillary sinus front wall, and frontal bone defects were reconstructed successfully with scapular bone grafts. Clinical evaluation of the patients at 6 to 24 months of follow-up was considered satisfactory. Minimal donor site morbidity was observed. Scapular bone grafts adapted nicely to the recipient area, and bony union was complete as demonstrated by 3-dimensional computed tomography scans. CONCLUSIONS Reconstruction of orbital, maxillary sinus front wall, and frontal bone defects with scapular bone grafts is an easy and safe procedure with minimal donor site morbidity. Scapular bone graft is a good reconstructive option for orbital, maxillary sinus front wall, and frontal bone defects.
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Affiliation(s)
- Aydin Turan
- From the Departments of *Plastic, Reconstructive and Aesthetic Surgery, †Radiology, and ‡Pathology, Gaziosmanpaşa University Medical School, Tokat, Turkey
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Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube. Clin Exp Otorhinolaryngol 2015; 8:250-5. [PMID: 26330920 PMCID: PMC4553356 DOI: 10.3342/ceo.2015.8.3.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach. METHODS A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained. RESULTS In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries. CONCLUSION During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.
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O TM, Richard MJ, Cullinane DM, Binetter DJ, Fay A, Der Sarkissian R. A Biomechanical Evaluation of Auricular Cartilage Autografts in Orbital Floor Defect Repair. Orbit 2015; 34:121-6. [PMID: 25905861 DOI: 10.3109/01676830.2015.1014504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Auricular cartilage is used as a surgical implant in the management of orbital floor fractures. However, no specific parameters exist regarding the use/limitations of this potential graft. In order to determine the mechanical efficacy of adult auricular cartilage grafts, a mechanical model was developed and studied for structural threshold size limits. METHODS Thirty-seven cadaveric auricular cartilage specimens were tested in a laboratory. A plexiglass baseplate was created with four different sized holes, defined as 1.0×, 1.2×, 1.4×, and 1.6× the mean minor axis of the specimens. Each specimen was used to bridge one hole under increasing loads until mechanical failure. Structural stiffness at three different loading stages, structural failure strength, and percent failure of the entire system for each defect size was calculated. RESULTS Specimens tested on 1.0×, 1.2×, 1.4× and 1.6× defects demonstrated 0%, 0%, 20%, and 60% system failure rates, respectively. Structural stiffness curves showed a similar trend, with ANOVA demonstrating a significant difference in mechanical properties between defect sizes (p = 0.03). The curve representing 1.6 × defect size demonstrated significantly reduced structural stiffness relative to 1.0×, 1.2×, and 1.4× curves. There was no statistical difference between 1.2× and 1.4× testing sets (p = 0.09). CONCLUSION A clinically significant biomechanical and functional threshold exists between 1.2×and 1.4× defect sizes. Given a mean minor axis of 2.06 cm, orbital blow-out defects <2.4 cm (1.2 × 2.06 cm) are suitable for auricular cartilage grafts; fractures >2.4 cm may require a more rigid material. Cartilage grafts that allow failure, however, may better protect the globe in subsequent injury.
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Affiliation(s)
- Teresa M O
- Department of Otolaryngology, Vascular Birthmark Institute of New York, Lenox Hill and Manhattan Eye, Ear, and Throat Hospitals, North Shore LIJ Health System , New York, New York , USA
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Stoor P, Mesimäki K, Lindqvist C, Kontio R. The use of anatomically drop-shaped bioactive glass S53P4 implants in the reconstruction of orbital floor fractures--A prospective long-term follow-up study. J Craniomaxillofac Surg 2015; 43:969-75. [PMID: 25957104 DOI: 10.1016/j.jcms.2015.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/10/2015] [Accepted: 03/23/2015] [Indexed: 12/01/2022] Open
Abstract
An isolated fracture of the orbital floor needs reconstruction if there is a clear herniation of adipose tissue or of the rectus inferior muscle into the maxillary sinus. A prospective study was carried out treating 20 patients with an isolated blow-out fracture of the orbital floor or with a combined zygomatico-orbito-maxillary complex fracture, using a newly designed anatomically drop-shaped implants made of bioactive glass (BAG) S53P4. Computed tomography (CT) was performed immediately postoperatively to confirm the correct position of the plate. The patients were followed up for an average of 32 months clinically and radiologically with magnetic resonance imaging (MRI) for an average of 31 months. None of the patients had any signs of complications related to the implant and the clinical outcome was very good. None of the patients had persisting diplopia. The level of the pupillas was normal in 15 of 20 patients. Minor hypo-ophthalmos ranging from 0.5 to 1.0 mm was observed in three patients, and moderate hypo-ophthalmos of 2.0 mm was seen in one patient. Hyperophthalmos of 1.0 mm was seen in one patient. Minor enophthalmos on the operated side ranging from 0.5 to 1.0 mm was seen in eight patients. Mild to moderate paraesthesia of the infraorbital nerve was observed in six patients. The immediate postoperative CT and the long term follow-up MRI revealed that the drop-shaped BAG implants retained their correct position in the orbital floor and did not show any evidence of losing their original shape or material resorption. No adverse tissue reaction was associated with the material. Due to the anatomical drop shape, the implants could successfully maintain the orbital volume and compensate for the retrobulbar adipose tissue atrophy.
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Affiliation(s)
- P Stoor
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Karri Mesimäki
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Christian Lindqvist
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Oral and Maxillofacial Surgery, Helsinki University, Helsinki, Finland
| | - Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Bande CR, Daware S, Lambade P, Patle B. Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study. J Maxillofac Oral Surg 2014. [PMID: 26225051 DOI: 10.1007/s12663-014-0716-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. There is no intact bone even near the defect area except the thin bone rim surrounding the blowout fracture. The purpose of this defect repair is to support orbital contents, free entrapped tissue, and, especially, restore the original orbital volume. MATERIAL AND METHODS Ten patients (seven males and three females) who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. CONCLUSION The collection in the maxillary sinus due to fracture of floor of orbit, blood and bony fragments collected in the maxillary sinus can be easily drained and removed after removal of anterior wall of maxillary sinus and through the same approach you can reduce the floor of orbit manually to the proper position which helps to decease the orbital floor defect.
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Affiliation(s)
- Chandrashekhar R Bande
- Department of Oral and Maxillo-facial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
| | - Surendra Daware
- Department of Oral and Maxillo-facial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
| | - Pravin Lambade
- Department of Oral and Maxillo-facial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
| | - Bhaskar Patle
- Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Waddhamana Road, Wanadongari, Hingna, Nagpur, 440010 Maharashtra India
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Abstract
Orbital floor injuries, alone or combination with other facial fractures, are one of the most commonly encountered midface fractures. Techniques for orbital reconstruction have migrated away from autogenous bone grafts to well-tolerated alloplasts, such as titanium and Medpor. Material for reconstructing the orbit can then be selected based on requirements of the defect matched to the mechanical properties of the material. Material selection is largely and ultimately dependent upon surgeon preference.
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Gunarajah DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: a systematic review. J Oral Maxillofac Surg 2013; 71:550-70. [PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/10/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults. MATERIALS AND METHODS A systematic search of the English literature was performed in the databases of PubMed, Cochrane Library, and EMBASE. The study selection process was adapted from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, and 55 articles complied with the study inclusion criteria. The primary outcome measures were diplopia, enophthalmos, graft extrusion/displacement, and infection related to the graft material. The secondary outcome measures were infraorbital paresthesia, orbital dystopia, orbital soft tissue entrapment, and donor-site complications. RESULTS Of 55 articles, 41 (74.5%) evaluated were retrospective case series, 9 (16.4%) were retrospective case-control studies, 3 (5.5%) were controlled trials, and 2 (3.6%) were prospective case series. Autogenous graft materials were predominantly used in 19 studies, alloplastic materials were used in 33 studies, and the remaining 3 articles reported on allogeneic materials. Overall, 19 different types of implant materials were used in 2,483 patients. Of 827 patients with diplopia before surgery, 151 (18.3%) had diplopia postoperatively. Of 449 patients with enophthalmos before surgery, 134 (29.8%) had enophthalmos postoperatively. Only 2 patients (0.1%) and 14 patients (0.6%) had graft extrusion/displacement and infection related to the graft material, respectively; alloplastic biomaterials were used in all of these cases. CONCLUSIONS All graft materials used were successful to variable degrees because all studies reported improvement in terms of the recorded outcome measures. A guideline for choice of implant material based on defect size was developed.
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Forces affecting orbital floor reconstruction materials – A cadaver study. J Craniomaxillofac Surg 2013; 41:e24-8. [DOI: 10.1016/j.jcms.2012.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 05/11/2012] [Accepted: 05/14/2012] [Indexed: 11/22/2022] Open
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Open reduction versus endoscopically controlled reconstruction of orbital floor fractures: a retrospective analysis. Int J Oral Maxillofac Surg 2012; 41:489-93. [DOI: 10.1016/j.ijom.2012.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 12/29/2011] [Accepted: 01/13/2012] [Indexed: 11/22/2022]
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Transzygomatic Kirschner wire fixation for the treatment of blowout fracture. J Plast Reconstr Aesthet Surg 2012; 65:875-82. [PMID: 22373828 DOI: 10.1016/j.bjps.2012.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/15/2011] [Accepted: 01/23/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Total orbital floor reconstruction with sheet-shape materials is available for the treatment of extensive and crushed-type blowout fractures. Simple blowout fractures, on the other hand, require only manual reduction without fixation. Although several types of blowout fractures do not require total reconstruction, some fixation is usually necessary. METHODS Eighteen cases of blowout fracture were treated with transzygomatic Kirschner wire fixation between 2002 and 2009. This technique was applied to simple fracture cases in which periorbital soft tissue re-herniated through the floor defect into the maxillary sinus after manual reduction, despite improvement of the extra-ocular muscle entrapment. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone graft in 13 cases. RESULTS Mean follow-up was 12.5 months. Mild diplopia remained as a subjective symptom in one case. None of the cases developed major complications or conspicuous scars on the cheek. CONCLUSIONS Transzygomatic Kirschner wire fixation for blowout fracture has the advantages of precise and rigid fixation of all parts of the inferior floor, minimal morbidity without requiring an orbital approach and long-term safety without artificial remnants. This technique can be applied for the treatment of simple blowout fractures.
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Lieger O, Schaller B, Zix J, Kellner F, Iizuka T. Repair of Orbital Floor Fractures Using Bioresorbable Poly-L/DL-Lactide
Plates. ACTA ACUST UNITED AC 2010. [DOI: 10.1001/archfaci.2010.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Olivier Lieger
- Department of Cranio-Maxillofacial Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland (Dr Lieger); and Departments of Cranio-Maxillofacial Surgery (Drs Schaller, Zix, and Iizuka) and Radiology (Dr Kellner), University Bern, University Hospital, Bern, Switzerland
| | - Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland (Dr Lieger); and Departments of Cranio-Maxillofacial Surgery (Drs Schaller, Zix, and Iizuka) and Radiology (Dr Kellner), University Bern, University Hospital, Bern, Switzerland
| | - Jürgen Zix
- Department of Cranio-Maxillofacial Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland (Dr Lieger); and Departments of Cranio-Maxillofacial Surgery (Drs Schaller, Zix, and Iizuka) and Radiology (Dr Kellner), University Bern, University Hospital, Bern, Switzerland
| | - Frauke Kellner
- Department of Cranio-Maxillofacial Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland (Dr Lieger); and Departments of Cranio-Maxillofacial Surgery (Drs Schaller, Zix, and Iizuka) and Radiology (Dr Kellner), University Bern, University Hospital, Bern, Switzerland
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland (Dr Lieger); and Departments of Cranio-Maxillofacial Surgery (Drs Schaller, Zix, and Iizuka) and Radiology (Dr Kellner), University Bern, University Hospital, Bern, Switzerland
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Betz MW, Caccamese JF, Coletti DP, Sauk JJ, Fisher JP. Challenges Associated with Regeneration of Orbital Floor Bone. TISSUE ENGINEERING PART B-REVIEWS 2010; 16:541-50. [DOI: 10.1089/ten.teb.2009.0393] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Martha W. Betz
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - John F. Caccamese
- Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, Maryland
| | - Domenick P. Coletti
- Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, Maryland
| | - John J. Sauk
- University of Louisville, Dental School, Louisville, Kentucky
| | - John P. Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
- Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, Maryland
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Ram H, Singh RK, Mohammad S, Gupta AK. Efficacy of Iliac Crest vs. Medpor in Orbital Floor Reconstruction. J Maxillofac Oral Surg 2010; 9:134-41. [PMID: 22190772 PMCID: PMC3244104 DOI: 10.1007/s12663-010-0047-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022] Open
Abstract
AIM The present study is to compare the effectiveness of iliac crest graft and medpor implant, for repairing traumatic orbital floor defects. MATERIALS AND METHODS A total of 20 patients were included in the study. Autogenous iliac crest graft and medpor implant was used in 10 patients of the each group. Patients were evaluated for the presence or absence of diplopia, enophthalmos, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8 mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. RESULTS All patients were successfully treated by restoration of the orbital wall continuity. Follow-up was done at 1-12 weeks. One patient had postoperative infection. There was no graft extrusion. CONCLUSIONS Both the groups showed satisfactory results, but group II was better than group I, as there was no donor site morbidity. Porous polyethylene (Medpor) is a biocompatible and high-density polyethylene implant. It is well tolerated by surrounding tissue, and its porous structure is rapidly infiltrated by host tissue. It is a highly stable and somewhat flexible porous alloplast that has rapid tissue in growth into its pores.
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Affiliation(s)
- Hari Ram
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - R. K. Singh
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
| | - Anup Kumar Gupta
- Department of Oral and Maxillofacial Surgery, CSM Medical University (Erstwhile King George’s Medical University), Lucknow, India
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Verdugo F, D'Addona A, Pontón J. Clinical, tomographic, and histological assessment of periosteal guided bone regeneration with cortical perforations in advanced human critical size defects. Clin Implant Dent Relat Res 2010; 14:112-20. [PMID: 20491815 DOI: 10.1111/j.1708-8208.2009.00235.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Large osseous defects that fail to heal spontaneously require ridge augmentation prior to implant placement. The periosteum can act as an effective barrier membrane. Little is known about the influence of bone decortication in enhancing guided bone regeneration outcomes. PURPOSE The aim of the present study was a clinical, tomographic, and histological evaluation of bone healing in large defect sites treated with cortical perforations without the use of other membranes but the periosteum. MATERIAL AND METHODS Ten consecutive patients undergoing ridge augmentation on the pre-maxilla due to severe bone loss were followed for an average of 35 months. Recipient sites were cortico-perforated and augmented using a combination of autogenous particulate and block grafts. The periosteal membrane was preserved and it fully covered the autografts. Histological analysis was performed in four sites from a trephine core taken at the time of implant osteotomy preparation. Tomographic assessment (computed tomography [CT] scan) at baseline and post-augmentation evaluated graft volume maintenance. RESULTS Recipient sites were re-entered for implant placement showing good incorporation of the grafts with minimal volume loss. Biopsy specimens showed viable bone rich in osteoblast-like cells with little or no inflammatory cells. Clinical exam revealed absence of implant transparency, mucosal recession, mobility, bleeding on probing, or suppuration at follow-up. CT scan evaluation showed an average increased bucco-lingual width at the recipient site of 8.1 mm ± 0.9 (2.5 fold) versus a 3.2 ± 0.9 at baseline (p < .0001; CI 95%: 4.04-5.71 mm), maintaining on average 98% of the augmented width at 2.9 years. CONCLUSIONS Periosteal preservation seems to be sufficient as a barrier membrane to protect particulate or block osseous grafts provided that good primary closure is achieved. Bone decortication may enhance clinical and histological outcomes. Graft viability (biopsy specimens) and volume maintenance (CT evaluation) remained stable 35 months post-augmentation.
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Affiliation(s)
- Fernando Verdugo
- VA Hospital, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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Patel M, Betz MW, Geibel E, Patel KJ, Caccamese JF, Coletti DP, Sauk JJ, Fisher JP. Cyclic Acetal Hydroxyapatite Nanocomposites for Orbital Bone Regeneration. Tissue Eng Part A 2010; 16:55-65. [DOI: 10.1089/ten.tea.2009.0027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Minal Patel
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Martha W. Betz
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | - Elyse Geibel
- Department of Psychology, University of Maryland, College Park, Maryland
| | - Ketan J. Patel
- Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, Maryland
| | - John F. Caccamese
- Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, Maryland
| | - Domenick P. Coletti
- Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, Maryland
| | - John J. Sauk
- School of Dentistry, University of Louisville, Louisville, Kentucky
| | - John P. Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
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Salgarelli A, Bellini P, Multinu A, Landini B, Consolo U. Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma. Br J Oral Maxillofac Surg 2009; 47:298-301. [DOI: 10.1016/j.bjoms.2009.01.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2009] [Indexed: 11/26/2022]
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Multiple fractures involving the orbit and incidental finding of large fourth ventricular epidermoid. J Craniofac Surg 2009; 20:261-2. [PMID: 19165044 DOI: 10.1097/scs.0b013e318184339b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Epidermoid tumors located in the fourth ventricle are exceedingly rare, and the patients usually present with headaches, vertigo, and/or disequilibrium. We discuss the management of orbital floor and lateral wall fracture in a patient who was also incidentally diagnosed to have a large fourth ventricular epidermoid cyst. Although because of their availability and ease of use many allografts have been described, when available, the use of similar membranous bone of equivalent thickness makes the bone graft ideally suited for reconstruction of the orbital floor.
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Verdugo F, Simonian K, Nowzari H. Periodontal Biotype Influence on the Volume Maintenance of Onlay Grafts. J Periodontol 2009; 80:816-23. [DOI: 10.1902/jop.2009.080572] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chrobok V, Pellant A, Novák J, Brozík J. Reconstruction of an orbital floor fracture in a 4-year-old child. ACTA MEDICA (HRADEC KRALOVE) 2008; 51:229-231. [PMID: 19453089 DOI: 10.14712/18059694.2017.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors present a case of a 4-year-old girl with an orbital floor fracture. During surgery absorbable collagenous mesh (Pelvicol) was placed between the bone wall and the orbital periosteum. Pelvicol was selected as a natural xenogeneic tissue (porcine dermis) ready for first use in the reconstruction of the orbital floor fracture. The patient has fully recovered without any symptoms.
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Affiliation(s)
- Viktor Chrobok
- Regional Hospital Pardubice, University Pardubice, Faculty of Medical Studies, Department of Otorhinolaryngology, Head and Neck Surgery, Czech Republic.
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Fernandes R, Fattahi T, Steinberg B, Schare H. Endoscopic Repair of Isolated Orbital Floor Fracture With Implant Placement. J Oral Maxillofac Surg 2007; 65:1449-53. [PMID: 17656267 DOI: 10.1016/j.joms.2006.10.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 05/21/2006] [Accepted: 10/06/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was designed to assess the use of the endoscopic transmaxillary approach to correcting orbital blowout fractures (OBFs) with placement of alloplastic implants. MATERIALS AND METHODS This was a prospective study of patients treated in the Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville over a 6-month period, July to December 2005. Ten patients (7 males, 3 females, age range 19 to 47 years [average age 37.3 years]) met the inclusion criteria for the study and consented to undergo surgical repair. The injury was most commonly secondary to assault (6 cases); the remainder were secondary to motor vehicle collisions. The time from injury to correction ranged from 3 to 36 days (average, 10.9 days). A computed tomography scan with axial and coronal views was obtained in each patient at the time of presentation. All patients who met the inclusion criteria for the study underwent an endoscopic-assisted transmaxillary repair of their OBF with placement of a Medpor implant (Porex Surgical Products, Newnan, GA). RESULTS Of the 10 patients, 9 presented with diplopia preoperatively and 4 had associated entrapment on upward gaze. One patient did not have entrapment or diplopia but had a fracture larger than 2 cm(2). All patients underwent successful OBF repair with placement of a Medpore implant through the endoscopic transmaxillary approach, and all experienced resolution of preoperative diplopia and/or entrapment. None of the patients developed enophthalmos at a mean follow-up of 12.7 weeks. CONCLUSIONS The endoscopic transmaxillary approach to correcting OBF is an excellent alternative to the transconjunctival approach. This approach carries a very low morbidity and may be used in circumstances in which conventional approaches are not feasible.
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Affiliation(s)
- Rui Fernandes
- Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
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Abstract
Orbital blow-out fractures reconstruction aims to restore the continuity of the orbital floor, to provide support of orbital contents and prevent soft tissues' fibrosis. Different materials have been tested over the years to reach this purpose. Traditionally, autogenous grafts have been used as the material of choice; in recent years alloplastic materials have gained popularity because of their availability and ease of use. The purpose of this study was to review materials used in orbital floor reconstructive surgery at the Department of Maxillo-Facial Surgery of University of Rome "La Sapienza", with emphasis on their biocompatibility, their shaping features, and mechanical properties. This report presents the results obtained by the application of these products on 379 patients who underwent surgical treatment for blow-out fractures from 1995 to 2003: the diagnosis of fracture of the orbital floor was based on clinical symptoms and CT axial scanning through coronal reconstruction. Follow-up period spanned from 1 to 8 years.
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Affiliation(s)
- Claudio Rinna
- University of Rome La Sapienza, Department of Maxillo-Facial Surgery, Rome, Italy.
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Affiliation(s)
- Jason K Potter
- University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9109, USA
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Kontio R. Treatment of orbital fractures: the case for reconstruction with autogenous bone. J Oral Maxillofac Surg 2004; 62:863-8. [PMID: 15218567 DOI: 10.1016/j.joms.2004.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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Enislidis G. Treatment of orbital fractures: the case for treatment with resorbable materials. J Oral Maxillofac Surg 2004; 62:869-72. [PMID: 15218568 DOI: 10.1016/j.joms.2003.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Georg Enislidis
- University-Clinic for Oral and Maxillofacial Surgery, General Hospital Vienna, Vienna, Austria.
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Elmazar H, Jackson IT, Degner D, Miyawaki T, Barakat K, Andrus L, Bradford M. The efficacy of Gore-Tex vs. hydroxyapatite and bone graft in reconstruction of orbital floor defects. EUROPEAN JOURNAL OF PLASTIC SURGERY 2003. [DOI: 10.1007/s00238-002-0448-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jank S, Emshoff R, Schuchter B, Strobl H, Brandlmaier I, Norer B. Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:16-22. [PMID: 12539022 DOI: 10.1067/moe.2003.11] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate whether a flexible, biodegradable material (Ethisorb) shows better long-term results with regard to diplopia, bulbus motility, and exophthalmos/enophthalmos compared to the use of lyophilized dura-patches and polydioxanone (PDS) foils. METHODS During a period of 6 years 435 patients with an orbital fracture were investigated retrospectively. Inclusion criteria were patients with fractures of the orbital floor with a maximum size of 2 x 2 cm. Bulbus motility, exophthalmos, enophthalmos, and diplopia were investigated during a period of 2 years. RESULTS One hundred twenty orbital floors were reconstructed by lyophilized dura-patches, 81 by PDS, and 136 by Ethisorb. An exploration without an implantation was performed in 91 patients. The long-term investigation 12 to 15 months after surgery showed an exophthalmos and enophthalmos incidence of 1%, whereas a reduced bulbus motility and diplopia were found in 5% and 4%, respectively. Fifteen to 24 months after surgery 2% of the patients had an exophthalmos and 1% had an enophthalmos. A reduction of bulbus motility was found in 4% of the patients, and diplopia was found in 3%. The use of Ethisorb resulted in a significantly lower incidence of exophthalmos 3 months after surgery compared to PDS. CONCLUSION The low rate of acquired bulbus motility demonstrates acceptable results in using Ethisorb in the floor of the orbit.
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Affiliation(s)
- Siegfried Jank
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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Siddique SA, Mathog RH. A comparison of parietal and iliac crest bone grafts for orbital reconstruction. J Oral Maxillofac Surg 2002; 60:44-50; discussion 50-2. [PMID: 11757006 DOI: 10.1053/joms.2002.29072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study evaluated the results of cranial (membranous) versus iliac crest (endochondral) bone grafts as implants to correct post-traumatic globe malposition and/or diplopia. PATIENTS AND METHODS Twenty-two patients underwent 25 orbital reconstructions with bone for enophthalmos, hypophthalmos, and diplopia after trauma to the orbit. Inclusion criteria consisted of at least 4 months postsurgical follow-up, pre- and postsurgical quantitative orbital measurements, photographic documentation, and complete medical records regarding inpatient and outpatient data. RESULTS Nine cranial bone grafts and 16 iliac crest grafts were placed. Ages were similar in both groups. The average follow-up was 24 months for the cranial graft group (range, 4 to 54 months) and 18 months for the iliac crest graft group (range, 4 to 51 months). Preoperative enophthalmos averaged 4.11 and 5.06 mm in the cranial and iliac crest groups, respectively, and postoperatively the measurements were 1.78 and 1.37 mm, respectively. Changes in hypophthalmos generally reflected changes in the enophthalmos correction. In 10 patients diplopia was corrected by the procedure. There was a statistically significant change in the enophthalmos of patients when comparing pre- and postoperative status, but no statistically significant difference between the results of the cranial and iliac crest graft groups. CONCLUSION There is no difference in the ability of cranial and iliac crest bone grafts to correct post-traumatic enophthalmos.
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Affiliation(s)
- Shoab A Siddique
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI 48201, USA
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Aitasalo K, Kinnunen I, Palmgren J, Varpula M. Repair of orbital floor fractures with bioactive glass implants. J Oral Maxillofac Surg 2001; 59:1390-5; discussion 1395-6. [PMID: 11732018 DOI: 10.1053/joms.2001.27524] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The ideal management of orbital floor fractures has been highly controversial. Many implants, both autogenous and alloplastic, have been used to span the defects. This study evaluated the use of bioactive glass implants (BAG-implant, S53P4; Abmin Technologies Ltd, Turku, Finland) for the repair of orbital floor defects caused by blunt facial trauma. PATIENTS AND METHODS This retrospective review of 36 patients was carried out from 1995 to 1999. All patients were diagnosed with an orbital floor fracture or a large orbital blowout fracture. The BAG-implant was placed over the defect, using a subciliary or transconjunctival approach. No screw fixation was used when the implant was the correct size. Follow-up examination was done at 1 and 3 months after surgery. Twenty-eight (82%) of the patients were also seen at one-year follow-up (21 men and 7 women). RESULTS The implants did not cause a foreign body reaction in the bone or soft tissue. There was no sign of resorption or infection, nor postoperative extrusion, hemorrhage, or displacement of the implant. Diplopia was seen preoperatively in 17 cases (61%) and postoperatively in 5 cases (18%). In 1 patient, the implant was removed 3 months after operation because of diplopia. Infraorbital nerve paresthesia was seen preoperatively in 9 patients (32%) and postoperatively in 5 patients (18%). The functional and cosmetic results were good at the 1-year follow-up. CONCLUSION The BAG-implant is a well-tolerated material in orbital floor reconstruction. It provides a favorable environment for an uncomplicated healing process because it is bioactive and biocompatible and because it causes new bone formation.
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Affiliation(s)
- K Aitasalo
- Turku University Central Hospital, Turku, Finland.
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Kinnunen I, Aitasalo K, Pöllönen M, Varpula M. Reconstruction of orbital floor fractures using bioactive glass. J Craniomaxillofac Surg 2000; 28:229-34. [PMID: 11110155 DOI: 10.1054/jcms.2000.0140] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The management of orbital floor fractures continues to be debated. Bioactive glasses and glass-ceramics are in the new group of materials developed for the repair of bone defects which are beyond any innate healing capacity due to their size. OBJECTIVE We compared the use of alloplastic implants (bioactive glass) with conventional autogenous grafts (cartilage--plus or minus Iyophilized dura) for the repair of orbital floor defects after trauma. MATERIAL AND METHODS Twenty-eight patients having orbital floor fractures with persistent diplopia, enophthalmos, and/or infraorbital nerve paraesthesia were operated on from 1991 to 1995 at Turku University Central Hospital. Reconstruction was either with bioactive glass (S93P4) or autogenous cartilage implants. RESULTS Postoperative tomograms in the 28 patients showed adequate maintenance of orbital and maxillary sinus volume without any evidence of resorption in either group. None of 14 patients in the study group had any evidence of dystopia or complications relating to implants follow-up. One had infraorbital nerve paraesthesia and another had entropion postoperatively. Among the 14 control subjects there were three cases of persistent diplopia, two of infraorbital nerve paraesthesia and one of enophthalmos. CONCLUSION Bioactive glass implants are well-tolerated and seem to be a promising repair material for orbital floor fractures. Their use leads to less morbidity as no donor site operation is needed. Also it provides favourable healing as it is bioactive, biocompatible and causes new bone formation.
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Affiliation(s)
- I Kinnunen
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Central Hospital, Finland
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