Changes in Volume and Bone Density of Calvarial Grafts After Two Years of Orbital Reconstruction.

One of the greatest challenges in orbital reconstruction is to obtain adequate orbital volume and globe projection after traumatic injury. Autologous bone graft has been considered the gold standard for orbital floor reconstruction, but the harvesting yields many possible complications, such as donor site morbidity. Bone resorption is a frequent problem that can lead to insufficient volume after graft placement. There is a theoretically lower resorption rate of skull bone grafts, even though the exact amount is not known yet. This study is the first to evaluate bone volume and density changes of calvarial split bone grafts after orbital floor reconstruction with a 2-year follow-up. Bone volume and density of calvarial split grafts were determined using computed tomography scans and the software program RadiAnt Dicom Viewer in a total of 10 patients with orbital floor fracture reconstruction. Computed tomography scans taken immediately after surgery (T0) and after a postoperative period of 2 years (T1) were evaluated. The authors found a mean bone volume reduction of 34.25% after 2 years. Bone density was still high after 2 years (over 850 HU), with a mean reduction of 8%. Based on these findings, calvarial split bone grafts represent the ideal reconstruction material for orbital floor fractures.

Combined use of titanium mesh and resorbable PLLA-PGA implant in the treatment of large orbital floor fractures.

BACKGROUND: A variety of alloplastic permanent and resorbable materials have been successfully used in orbital floor reconstruction; nevertheless, they both have shown disadvantages in the reconstruction of large orbital floor defects. We believe that, by combining both types of implants, the disadvantages could be diminished. METHODS: This is a retrospective study that included all patients with large orbital floor defects (>2 × 2 cm), pure or in association with other facial fractures, treated in our service with the combined use of titanium mesh and the resorbable implant LactoSorb. RESULTS: We included 20 patients, 7 had pure blowout fractures and the rest had other associated maxillofacial fractures. All of them had a large orbital floor defect with entrapment of periorbital tissue and herniation into the maxillary sinus. Mean hospital stay was 2 days, and our follow-up period was for at least 3 months. Seventeen patients had complete coverage of their floor defect with restoration of orbital volume, normal globe position, and full extraocular motility. We report 3 cases of enophthalmos and 2 cases of ectropion. Follow-up tomographic scans showed incomplete implant coverage of the orbital floor in 2 cases and a misplaced implant in the other. Subsequent operation was needed for correction. CONCLUSIONS: We believe that the combination of both implants is a good option for the reconstruction of large orbital floor defects. It takes full advantage of their intrinsic properties while at the same time lowers the disadvantages of their individual use. Complications were attributed to technical errors and not to the combination of both materials.

Multivectorial, external halo-assisted midface distraction in patients with severe hypoplasia.

Osteogenesis distraction is an increasingly used technique for the correction of facial deformities because it offers a faster and more controlled growth of the hypoplasic bone along with the elongation of the soft tissues. In this article, we describe the technique and our experience in midface distraction using an external multivectoral distraction device (BLUE Device; W. Lorenz, Jacksonville, FL) and custom-made midface osteotomies for the correction of severe hypoplasia.