Orbital Floor Reconstruction: The Surgical Dilemma
Nilesh K Shende, Vinita A Puri, Akshay P Anchan, Chaitanya G Patil, Kapil S Agrawal
BACKGROUND: Orbital fractures are classified as isolated blowout fractures or those associated other maxillofacial injuries (Le Fort II and III fractures, zygomaticomaxillary complex (ZMC) fractures, and nasoorbitoethmoid (NOE) fractures. In orbital floor reconstruction, autogenic materials like bone, cartilage, fascia, and periosteum are used which have the advantages of not being foreign bodies, low rate of infection and low cost but can cause morbidity and complications of the donor site. Alloplastic materials have the advantage of not requiring a donor site and shortened surgical time but can result in complications like fistula formation, infection, extrusion, and cyst formation. MATERIALS AND METHODS: In this observational retrospective study, case records of all patients with orbital floor defects needing reconstruction between August 2015 and December 2017 have been studied. RESULTS: Out of 76 patients explored for orbital floor fractures, 34 patients had their orbital floor reconstructed using autologous material. Conchal cartilage was used in 23 patients, the anterior maxillary bone was used in seven cases, and four cases were reconstructed using costal cartilage. One patient had enophthalmos, and two patients had diplopia postoperatively for which re-exploration of the orbital floor was done. CONCLUSION: Autologous materials like cartilage or bone are safe and biocompatible, available in abundance in the body and can be well contoured to orbital floor and have less risk of extrusion and infection when compared to alloplastic implants.