Introduction of mini-clinical evaluation exercise in teaching dental radiology-A pilot study.

INTRODUCTION: Workplace-based assessments are methods that can be applied for assessing competence and performance. One of these methods is the mini-clinical evaluation exercise (mini-CEX). This study was conducted to determine the role of mini-CEX in students' performance assessment on panoramic X-ray reporting at dental radiology course. MATERIALS AND METHODS: A workshop as training for the assessors and the participants was conducted before the primary test. All participants (n = 36) were randomly allocated into six groups. Each group had three seminars in which every student reported a panoramic X-ray. Students were directly observed and rated by an assessor on a modified mini-CEX rating form. Then, a self-assessment of the students and a systematic feedback session were performed. Finally, the students and the assessors were evaluated for the acceptability and satisfaction with this tool. RESULTS: The mean duration of the assessment and the feedback decreased significantly from the first seminar to the third seminar (P < .0001). Comparison of the results of the mini-CEX of all three assessments showed that students displayed a significantly better performance in evaluating the upper jaw and the soft tissue (P < .05). There was no significant improvement for the other aspects of the rating form. Overall, both students and assessors reported a high level of satisfaction in using the mini-CEX rating form. CONCLUSION: Due to the objectivity and transparency of the assessment, the mini-CEX helped to improve the performance on reporting panoramic X-rays. Besides that, the structured feedback had major impact on the improvement. Overall, the assessors and the participants reported a high level of satisfaction using the rating form. Therefore, the mini-CEX may be an effective method for performing workplace-based assessments to evaluate students' performance on reporting panoramic X-rays.

Evaluation of SPECT/CT in the assessment of inflammatory jaw pathologies.

PURPOSE: Since accurate diagnosis of inflammatory jaw diseases is still challenging, this study investigated the performance of three phase bone scintigraphy including SPECT/CT in the assessment of correct diagnosis and size of the affected bone tissue. METHOD: This retrospective study contained 31 patients with suspected jaw-related osteoradionecrosis, osteomyelitis or medication-related osteonecrosis of the jaw, which underwent 3-phase bone scintigraphy including SPECT/CT. Results were reviewed by two nuclear medicine physicians. Positive cases received surgery; negative ones were followed-up for six months. Both served as reference standard. Inflamed bone length was measured in the SPECT/CT images and postoperatively by a pathologist. RESULTS: 19 out of 20 positive cases and 10 out of 11 negative ones were classified correctly by SPECT/CT (sensitivity 95 %, specificity 91 %, accuracy 94 %, positive predictive value 95 %, negative predictive value 91 %). Regarding the length of affected bone, no significant difference (p = 0.23) could be observed between SPECT/CT and postoperative obtained values. Both correlated significantly (r = 0.86, p = 0.0001). CONCLUSION: SPECT/CT can safely detect different kinds of inflammatory jaw pathologies compared to other conventional imaging modalities. Lack of specificity of conventional scintigraphy ranging from 17 % to 71 % in earlier studies could be improved by adding CT-analysis. Additionally, SPECT/CT assists the surgeon in determining the expansion of the process (with focus on the length) preoperatively and thereby optimizing surgery planning.

Current concepts in cleft care: A multicenter analysis.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.

Subtarsal Versus Transconjunctival Approach-Esthetic and Functional Long-Term Experience.

PURPOSE: In addition to the transconjunctival approach, the subtarsal incision is one of the most commonly used procedures for surgical exploration of the orbital floor and infraorbital rim. However, available data are limited regarding validity and long-term esthetic and functional outcomes. The aim of this study was to verify the favorable clinical results of the subtarsal approach and compare these results with the transconjunctival procedure. MATERIALS AND METHODS: Forty-five patients (subtarsal group, n = 30; transconjunctival group, n = 15) were examined 6 to 30 months after surgical intervention using a standardized follow-up. Clinically noted complications, such as paresthesia, epiphora, or ocular foreign body sensation, were scored. Postoperative scar formation was investigated using the modified Vancouver Scar Scale (mVSS) and recorded according to standardized photographic documentation procedures. Photographic images were evaluated in a blinded manner by experts and nonexperts according to fixed criteria. Concomitant photographic evaluation was performed by age- and gender-matched healthy controls. Recorded data analyzed by χ2 test and unrelated samples analyzed by the Wilcoxon-Mann-Whitney test were statistically significant (P = .05). RESULTS: Comparable complication rates were found for the 2 approaches without any significant differences (P = .29). Using the subtarsal approach, discrete scar formation was discerned in 7 of 30 cases. Moreover, categorization by the mVSS showed that, in 93.3% of cases, the scar was measured as unremarkable hyper- or hypotrophy (mean, 1.7 of 10 possible points). No statistically significant differences in conspicuous scars and asymmetries were observed between the 2 approaches in the nonexpert and expert groups (P > .05). CONCLUSION: The results of the present study confirm that the subtarsal approach is a safe and esthetically favorable method.

Moving the mandible in orthognathic surgery - A multicenter analysis.

Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlössmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.

The Volume Behavior of Autogenous Iliac Bone Grafts After Sinus Floor Elevation: A Clinical Pilot Study.

Iliac crest is still regarded as one of the most viable source of autogenous graft materials for extensive sinus floor elevation. Three-dimensional resorption behavior has to be taken into account in anticipation of the subsequent insertion of dental implants. We performed 3-dimensional volume measurements of the inserted bone transplants in 11 patients (6 women and 5 men; mean age = 2.3 years) who underwent bilateral sinus floor elevation with autogenous iliac crest grafts. In order to determine the respective bone graft volumes, cone-beam computerized tomography studies of the maxillary sinuses were carried out directly after the operation (T0), as well as 3 months (T1) and 6 months (T2) postoperatively. The acquired DICOM (Digital Imaging and Communications in Medicine) data sets were evaluated using suitable analysis software. We evaluated statistical significance of graft volumes changes using a linear mixed model with the grouping factors for time, age, side, and sex with a significance level of P = .05. 38.9% of the initial bone graft volume, which amounted to 4.2 cm(3), was resorbed until T1. At T2, the average volume again decreased significantly by 18.9 % to finally reach 1.8 cm(3). The results show neither age nor side dependency and apply equally to both sexes. Without functional load, iliac bone grafts feature low-volume stability in sinus-augmentation surgery. Further clinical and animal studies should be done to detect the optimal timing for implant placement.

Noninvasive 3-dimensional evaluation of periorbital asymmetry in isolated unilateral orbital floor fractures.

OBJECTIVE: The study was carried out to evaluate the degree of asymmetry between the injured and contralateral periorbital region in isolated orbital floor fractures after surgery. STUDY DESIGN: The periorbital asymmetry of 35 patients with medium-sized orbital floor fractures that were surgically treated with alloplastic resorbable implants was evaluated and compared with that of a healthy control group using an optical 3-dimensional facial scanner. Distance measurements between facial surface landmarks, as well as volume measurements between the original image and an automatically generated mirror image, were performed using commercially available software. RESULTS: There were no statistically significant differences in the distance measurements (P > .05) and volume measurements (P > .05) within the groups or when the study group and control group were compared using the Student t test. CONCLUSIONS: Alloplastic resorbable implants can restore medium defects of the orbital floor without significant periorbital asymmetry. Automatically constructed mirror images can be a helpful tool for detecting asymmetries in faces.

Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial.

BACKGROUND: Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome. METHODS: Twenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated. RESULTS: Computer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn't change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001). CONCLUSIONS: The presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity. TRIAL REGISTRATION: DRKS00005181.

Consideration of effect of the amount of mandibular setback on the submental region in the planning of orthodontic-orthognathic treatment.

Aesthetic outcome has gained in importance in the treatment of patients with orthognathic problems. Historically, Class III malocclusions have historically been treated by isolated mandibular setback and maxillary advancement, whereas bimaxillary procedures have recently become the more common option. Functional outcome and stability have been discussed previously. The aim of this observational study was to evaluate the effect of mandibular setback (BSSO) on the cervical region. We studied 38 Class III patients (20 women and 18 men, mean (SD) age 25 (0.8) years) who we identified from our clinical records and who were treated between 1 January 2002 and 30 December 2012 with mandibular setback procedures and followed up for 6 months. To study the effect of the amount of mandibular setback on the aesthetic outcome we have distinguished between patients with less than 5mm setback and those with 5mm or more. In patients whose mandibular setback was less than 5mm there was no significant change in cervical length. However, it decreased significantly in patients in whom the movement was 5mm or more. Postoperatively the lip-chin-throat angle (p=0.02), the length of the lower lip (p=0.002), and the length of the upper lip (p=0.003) from the aesthetic line also differed significantly between the 2 groups. Our observations strongly suggest that all these relations should be considered when treatment is being planned to avoid an unpleasant aesthetic impact on the chin region.

Morphometric study of the scapular free flap and the free rib osteomyocutaneous flap.

The scapula free flap is often the first choice for reconstruction of bony defects of the facial skeleton. However, the vascularised rib as part of a free rib osteomyocutaneous flap may be a suitable second choice. We have investigated the morphology and clinical dimensions of the 7th rib and the scapula, and the ability of the available bone to carry dental implants. The age and sex of the cadaver, and the donor side, were also recorded. The dimensions of the scapulas and 7th ribs (n=130 of each) from 65 cadavers were measured at 4 different points using osteometric methods. Examination showed that bone from the scapula and 7th rib were sufficient for placement of implants. The 7th rib gave reliable measurements for both height and width, and a consistent relation between compact and cancellous bone. Although the scapula provided adequate compact and cancellous bone, there were variations depending on the segment of bone chosen. Bones from male cadavers were more suitable for implantation. In both the scapula and the 7th rib ageing had a significant adverse effect in only one dimension. Most points of measurement have satisfactory bony dimensions for insertion of dental implants.

Computer-assisted zygoma reconstruction with vascularized iliac crest bone graft.

BACKGROUND: The reconstruction of zygoma is a challenge with regard to aesthetic and reconstructive demands. METHODS: Pre-operative CT data were imported into specific surgical planning software. The mirror-imaging technique was used. A surgical guide transferred the virtual surgery plan to the operation site, whereby it fitted uniquely to the iliac donor site. A postoperative CT scan was obtained for comparing the actual postoperative graft position and shape with the pre-operative virtual simulation. RESULTS: A mean difference of 0.71 mm (SD ± 1.42) for the shape analysis and 3.53 mm (SD ± 3.14) for the graft position was determined. The calculation of the closest point distance showed a surface deviation of < 2 mm for the shape analysis with 83.6% of values and for the graft position with 35.7% of values. CONCLUSION: Virtual surgical planning is a suitable method for zygoma reconstruction with vascularized iliac crest bone graft, with good accuracy for restoring the three-dimensional anatomy.

Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study.

BACKGROUND: Surgical treatment and complications in patients with zygomatic bone fractures can lead to a significant degree of tissue trauma resulting in common postoperative symptoms and types of pain, facial swelling and functional impairment. Beneficial effects of local cold treatment on postoperative swelling, edema, pain, inflammation, and hemorrhage, as well as the reduction of metabolism, bleeding and hematomas, have been described.The aim of this study was to compare postoperative cooling therapy applied through the use of cooling compresses with the water-circulating cooling face mask manufactured by Hilotherm in terms of beneficial impact on postoperative facial swelling, pain, eye motility, diplopia, neurological complaints and patient satisfaction. METHODS: Forty-two patients were selected for treatment of unilateral zygomatic bone fractures and were divided randomly to one of two treatments: either a Hilotherm cooling face mask or conventional cooling compresses. Cooling was initiated as soon as possible after surgery until postoperative day 3 and was applied continuously for 12 hours daily. Facial swelling was quantified through a three-dimensional optical scanning technique. Furthermore, pain, neurological complaints, eye motility, diplopia and patient satisfaction were observed for each patient. RESULTS: Patients receiving a cooling therapy by Hilotherm demonstrated significantly less facial swelling, less pain, reduced limitation of eye motility and diplopia, fewer neurological complaints and were more satisfied compared to patients receiving conventional cooling therapy. CONCLUSIONS: Hilotherapy is more efficient in managing postoperative swelling and pain after treatment of unilateral zygomatic bone fractures than conventional cooling. TRIAL REGISTRATION: German Clinical Trials Register ID: DRKS00004846.

Esthetic outcome after soft tissue reconstruction of the face using deep dissection and composite facelift technique.

PURPOSE: Large defects in the face resulting from the excision of malignant tumors, trauma, and congenital malformation pose a significant challenge to reconstructive surgeons. Achieving good esthetic and functional outcomes is often very demanding. PATIENTS AND METHODS: A facelift technique was used in 47 patients (25 female, 22 male; age range, 17.5 to 82.3 years; mean age, 49.3 years) to replace lost tissue of the face from 2009 through 2012. The minimum defect size was 2 cm in diameter and the maximum was 8 cm. To achieve tension-free coverage with a reliable blood supply, a deep-plane dissection, including the skin and superficial musculoaponeurotic system (SMAS), was performed. The deep sub-SMAS dissection was extended into the neck and the contralateral part, as needed. A thick flap was created and composite lifting was performed. RESULTS: No significant deformity concerning the lower eyelids, nose, and lip was registered. Most scars could be placed in hidden regions and became undetectable after a year. The facial nerve function remained intact in all patients. CONCLUSION: Using these facelift techniques, including the incision, sub-SMAS dissection for volumetric positioning of the skin, and the SMAS flap, the closure of extensive facial defects with excellent functional and esthetic results is conceivable.

Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks.

The iliac bone crest is one of the most valuable regions for harvesting bone grafts, both vascularized and nonvascularized. Since the first commendable description of this region as a possible source for vascularized bone flaps by Taylor, little relevant information concerning the variations of the deep circumflex iliac vessels and their relationship to the neighboring structures has been published. The purpose of the current study was to examine this region clinically and anatomically, taking into consideration the former description by Taylor. We gathered all our findings on 216 iliac regions and proposed a new classification. In addition we measured the relationships between the deep circumflex iliac artery and important surgical landmarks. A comparison of our finding with other studies showed similarities and differences but was far more complete. Generally (92%) the deep circumflex iliac artery (DCIA) originated from external iliac artery (EIA) behind the inguinal ligament (IL) and passed cranio-laterally toward the anterior superior iliac spine, where it divided into two important branches. Four variations were observed of the DCIA. The deep circumflex iliac vein (DCIV) ran over (82.5%) or under (17.5%) the EIA. The superficial circumflex iliac vein (SCIV) was observed draining into the DCIV in some dissections. Three different variations of the superficial circumflex iliac artery (SCIA) were observed. The anatomical knowledge of these variations and their correlation to important surgical landmarks can help in harvesting the DCIA flap more safely and thus increasing the success rate while reducing donor site morbidity.

The intraoral approach to lateral osteotomy: the role of a diamond burr.

UNLABELLED: Lateral osteotomy is one of the most traumatic but critical steps in rhinoplasty and can dictate the aesthetic and functional outcomes. Many techniques and instruments to perform it have been suggested, with the objectives of increasing predictability, reliability, and easiness of this invasive approach. We used a 1.5-mm diamond burr via an intraoral approach to thin out the base of the nasal wall along the nasofacial crease in 24 patients. This technique was performed in patients seeking primary rhinoplasty (n = 6), correction of cleft nose deformities (n = 4), deformities due to trauma (n = 9), and secondary nose correction (n = 5). A high mucosal incision paranasally allowed easy access to the osteotomy line. The digital in-fracturing could be performed with light pressure and without extensive manipulation at any time during the rhinoplasty. The osteotomy took on average of 14.5 min (range = 11.00-19.80) and endoscopic examination showed no mucosal tearing. Postoperative swelling and hematoma were comparable to those of other techniques. Using a diamond burr via an intraoral approach is an easy, safe, and reliable method leading to predictable outcomes. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Microsurgical free flap reconstructions of head and neck region in 406 cases: a 13-year experience.

PURPOSE: The reconstruction of extended soft tissue and bony defects in the maxillofacial region with microsurgical flaps is considered to be the therapy of first choice. The aim of this retrospective study was to detect different influencing factors concerning flap survival. MATERIALS AND METHODS: We examined the data of 406 patient cases (121 female and 285 male cases; mean age, 57 years) undergoing reconstruction with a microsurgical flap in our facility between 1998 and 2010. In these cases 326 soft tissue flaps (radial forearm flap, scapula flap, latissimus dorsi flap, anterolateral thigh flap, lateral arm flap, and jejunum flap) and 80 bony flaps (fibula flap and deep circumflex iliac artery flap) were examined. Evaluated parameters were, among others, the timing of reconstruction, defect localization, and recipient vessels used (external vs internal jugular system), as well as anticoagulative management. We statistically analyzed data by means of a χ(2) test, taking account of the odds ratio with P < .05, which was deemed significant. RESULTS: The overall flap survival rate was approximately 92%, without any gender- or age-specific differences. Primary reconstructions proceeded distinctly more successfully than secondary reconstructions (P < .01). Likewise, the defect localization exerted a significant effect on the survival rate (P = .01), with a more caudal localization affecting flap survival positively. Finally, neither the anticoagulation regimen nor the choice of recipient vein system exercised an influence on the survival rate. CONCLUSIONS: Microsurgical tissue transfer is a convenient and reliable method in maxillofacial surgery, provided that one is aware of the determining factors for success.

Functional long-term results after the harvest of vascularised iliac bone grafts bicortically with the anterior superior iliac spine included.

The aim of this study was to evaluate the postoperative morbidity at the donor site and the long-term outcome after the harvest of bicortical iliac bone grafts, including the iliac crest and the anterior superior iliac spine (ASIS), by using a confirmed score. We retrospectively examined 54 consecutive patients who had had vascularised iliac bone grafts harvested to reconstruct different parts of the mandible. We used the Harris Hip Score to evaluate objectively the long-term postoperative morbidity at the donor site. Of 54 patients, 20 were female (37%) and 34 male (63%), with a mean age of 49 years (range 12-81). The causes of the bony defects were malignancy (n=37, 69%), benign tumours (n=7, 13%), osteomyelitis (n=9, 17%), and atrophy of the alveolar ridge (n=1, 2%). All transplants healed adequately. A total of 38/52 patients (73%) had a score of more than 80 points, which defines clinical success. Vascularised iliac bone grafts offer excellent bony dimensions with optimal shape to be used for reconstruction of different parts of the mandible. They can be harvested bicortically, including the iliac crest and the ASIS, with acceptable morbidity at the donor site. The Harris Hip Score is an appropriate tool for the evaluation of long-term impairment at the donor site after the harvest of vascularised iliac bone grafts, and it could be used to compare the results of different studies.

3D evaluation of postoperative swelling in treatment of bilateral mandibular fractures using 2 different cooling therapy methods: a randomized observer blind prospective study.

Surgical treatment and complications in patients with mandibular fractures leads to a significant degree of tissue trauma resulting in common postoperative symptoms and signs of pain, facial swelling, mandible dysfunction and limited mouth opening (trismus). Beneficial effects of local cold treatment on postoperative swelling, oedema, pain, inflammation and haemorrhage, as well as the reduction of metabolism, bleeding and haematomas have been described. The aim of this study was to compare postoperative cooling therapy by cooling compresses with the water-circulating cooling face mask by Hilotherm(®) in terms of beneficial effects on postoperative facial swelling, pain, mandible dysfunction, trismus and neurological complaints. Thirty-two patients were assigned for treatment of bilateral mandibular fractures and were divided randomly into treatment either with the Hilotherm(®) cooling face mask or with conventional cooling with cooling compresses. Cooling was initiated as soon as possible after surgery until postoperative day 3 continuously for 12h daily. Facial swelling was quantified by a 3D optical scanning technique. Pain, neurological complaints, mandibular dysfunction and the degree of mouth opening were measured for each patient. Patients receiving cooling therapy by Hilotherm(®) demonstrated less facial swelling, less pain, a tendency to fewer neurological complaints and were more satisfied when compared to conventional cooling. Hilotherm(®) is more superior in the management of postoperative swelling and pain after treatment of bilateral mandibular fractures when compared to conventional cooling.

Carotid sinus syndrome as the presenting symptom of cystadenolymphoma.

Carotid sinus syndrome is a serious manifestation of head and neck malignancy. The purpose of this study was to clarify the presence of carotid sinus syndrome in a patient with cystadenolymphoma. To our knowledge carotid sinus syndrome secondary to cystadenolymphoma has not been reported to date. A 45-year-old woman with one-week-old swelling in the left mandibular angle having disturbing symptoms of vertigo, consciousness and sinus arrest. Holter monitoring revealed several episodes of sinus arrest. Ultrasonography showed a well-defined space-occupying lesion of about 31 mm in length and 17 mm in width located in the deep lobe of the left parotid gland. Computerized tomography (CT) showed a large mass extending into the carotid space and protruding into the parapharyngeal space. Parotidectomy was performed. Surgical removal of the tumor resulted in complete amelioration of symptoms and disappearance of electrocardiogram abnormalities. Here we report on a clinical case of carotid sinus syndrome associated with cystadenolymphoma. To our knowledge carotid sinus syndrome secondary to cystadenolymphoma has not been reported to date, and is made more remarkable as a possible differential diagnosis after clarification of all possible causes. Early diagnosis and immediate management can minimize complications.

Radiologic and facial morphologic long-term results in treatment of orbital floor fracture with flexible absorbable alloplastic material.

PURPOSE: Although orbital floor fractures are frequently treated by the Ethisorb patch or polydioxanone foil, the utility of these treatments in extensive fractures remains controversial. The purpose of this study was to examine objectively the extent to which such flexible absorbable materials can restore orbital geometry in comminuted and defect fractures. MATERIALS AND METHODS: Twenty-one patients with isolated comminuted or defect fractures of the orbital floor (mean, 4.32 cm(2)) were recruited for this retrospective study. Using an infraorbital approach, 15 patients received an Ethisorb patch, whereas polydioxanone foil (0.25 mm) was used in the remaining cases. Follow-up examinations with cone-beam computed tomography and 3-dimensional facial scanning occurred on average 27.4 months postoperatively. Orbital heights and volumes were measured on the fracture side and compared with the unaffected side. Based on 3-dimensional facial scan data, the ocular bulb position was assessed in the sagittal and vertical directions. For all parameters, the difference between the left and right sides was calculated, which was statistically significant compared with the side difference of an age- and gender-matched control group using unpaired t test (P < .05). RESULTS: No statistically significant differences were observed in any variable between the surgical and control cohorts. A decreased diplopia rate of 38.14% was attained by the surgical intervention. CONCLUSION: The reconstruction of moderate to extensive orbital floor fractures can be provided with polydioxanone foil or the Ethisorb patch without significant changes in orbital geometry.