Advertisement

A Comparative Study of Orbital Blow Out Fracture Repair, Using Autogenous Bone Graft and Alloplastic Materials

  • Asok Kumar Saha
  • Saikat SamaddarEmail author
  • Amit Kumar
  • Arup Chakraborty
  • Biplab Deb
Original Article
  • 12 Downloads

Abstract

Maxillofacial trauma, a common injury in urban population following road traffic accident or act of interpersonal violence of which orbital floor fractures is common. It impairs the integrity of the extraocular muscles and may be accompanied by enophthalmos, orbital deformity and diplopia. Orbital reconstruction is essential to improve anatomical and visual deformity. Repair of orbital floor is done by autologous bone graft or synthetic implants. Compare outcome of orbital floor reconstruction in blow out orbital fracture using autogenous bone graft from iliac crest, outer table of mandible, alloplastic implant- silastic block and titanium mesh. 30 patients having orbital fractures were considered in study population. All the patients were treated by ORIF and repair of floor by subcilliary incision. Out of 30 patients, repair of orbital floor was done by autologous bone graft from iliac crest in 7 patients (Group A), bone graft from outer table of mandible in 5 patients (Group B), implant using silastic block in 8 patients (Group C) and titanium mesh in 10 patients (Group D). Factors analyzed were age, sex, cause of fracture and treatment outcome in terms of correction of pre operative diplopia and enophthalmos, rate of development of post operative infection, wound dehiscence and implant exposure. All patents were reviewed at 4 weeks and 12 weeks following operation. 71.42% of patients in Group A had early correction of diplopia and enophthalmos. This was 100% in rest of the groups. All patients had complete correction when assessed at 12 weeks post operatively. Post operative complication rate was 20% and 12.5% in Group B and C respectively. There were no complications in the rest of the groups within the follow up period. No statistically significant difference as to the chance of occurrence of complication could be found amongst the groups. Autologous bone graft has no immunological reaction but donor site morbidity. Silastic block may case immunological reaction, infection, poor drainage of orbital floor. But titanium mesh for orbital floor repair has excellent outcome and superior to other modality of treatment.

Keywords

Orbital floor Orbital fracture Bone graft Iliac crest Mandibular outer table Silastic block Titanium mesh 

Notes

Compliance with Ethical Standard

Conflict of interest

The author of this article declares that he/she has no conflict of interest.

Human and Animal Rights

Animals were not involved in the study.

Ethical Approval

All procedures performed in studies involving human population were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval from the Institutional Ethical Committee, Medical College and Hospital, Kolkata, was obtained for the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all the individual participants for whom identifying information is included in this article.

References

  1. 1.
    Forrest S, John C, Jonathan S, Charles NS (2010) Pearls of orbital trauma management. Semin Plasr Surg. 24(4):398–410CrossRefGoogle Scholar
  2. 2.
    Ahmad F, Kirkpatrick NA, Lyne J, Urdang M, Waterhouse N (2006) Buckling and hydraulic mechanisms in orbital blowout fractures: fact or fiction? J Craniofac Surg 17(3):438–441CrossRefGoogle Scholar
  3. 3.
    Anitha GL, Uma Maheswari G, Sethurajan B (2012) Mandibular symphysis graft versus iliac cortical graft in reconstructing floor in orbital blow out fracture: a comparative study. Ann Maxillofac Surg. 2(1):24–29CrossRefGoogle Scholar
  4. 4.
    Birur NP, Patrick S, Gurushanth K, Raghavan AS, Gurudath S (2017) Comparison of gray values of cone-beam computed tomography with hounsfield units of multislice computed tomography: an in vitro study. Indian J Dent Res 28(1):66CrossRefGoogle Scholar
  5. 5.
    Roncevic R, Malinger B (1981) Experience with various procedures in the treatment of orbital floor fractures. J Maxillofac Surg 9:81–84CrossRefGoogle Scholar
  6. 6.
    Kim JY, Choi G, Kwon JH (2015) Transantral orbital floor fracture repair using silastic tube. Clin Exp Otorhinolaryngol 8(3):250–255CrossRefGoogle Scholar
  7. 7.
    Patrick K, David A, Ralph E, David C, Paul N (1993) Bone-graft reconstruction of the monkey orbital floor with iliac grafts and titanium mesh plates: a histometric study. Plast Reconstr Surg 91(5):769–777Google Scholar
  8. 8.
    Edward E, Yinghui T (2003) Assessment of internal orbital reconstructions for pure blow out fractures: cranial bone grafts versus titanium mesh. J Oral Maxillofac Surg 61(4):442–453CrossRefGoogle Scholar
  9. 9.
    Gear AJ, Lokesh A et al (2002) Safety of titanium mesh for orbital reconstruction. Ann Plast Surg 48(1):1–9CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  • Asok Kumar Saha
    • 1
  • Saikat Samaddar
    • 2
    Email author
  • Amit Kumar
    • 1
  • Arup Chakraborty
    • 3
  • Biplab Deb
    • 4
  1. 1.Department of ENTM.G.M. Medical College and L.S.K. HospitalKishanganjIndia
  2. 2.Department of ENTPurulia Government Medical College and HospitalPuruliaIndia
  3. 3.Department of Community MedicineMedical College and HospitalKolkataIndia
  4. 4.Department of ENTMedical College and HospitalKolkataIndia

Personalised recommendations