Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft

Background: Orbital floor fractures constitute roughly 20% of all pediatric facial fractures. Reconstructive techniques are broadly subdivided into alloplastic and autologous. While pediatric literature exists for alloplastic orbital reconstruction, autologous orbital reconstruction studies are limited. Here we present several cases of posttraumatic pediatric orbital reconstruction utilizing autologous split rib graft. Methods: After IRB approval, a retrospective chart review was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt from 2003 to 2019. A review of relevant published literature was also performed. Results: From 2003 to 2019, 5 pediatric patients underwent orbital reconstruction with split rib graft. Of the 5 patients, 3 were female and 2 were male with an age range of 4 to 8 years old (mean 4.8). Two patients had isolated orbital blow-out fractures while 3 presented with concurrent midfacial fractures. In each patient, the orbit was reconstructed by contoured split rib corticocancellous graft. Average length of stay was 5.2 days. There were no postoperative pneumothoraces. Mean follow-up length was 18.7 months, with no rib donor site complications. Each patient had adequate orbital volume restoration with no postoperative globe malposition or persistent diplopia. Conclusion: Pediatric orbital fractures are complex and challenging injuries. While alloplastic reconstruction is common and reliable, the risks of foreign body implantation and fixation must be carefully considered in patients who have not yet reached skeletal maturity. This is especially pertinent in younger patients as orbital growth continues until approximately 9 years of age. Rib graft use for adult orbital reconstruction has been explored. Data in the pediatric literature has not been identified. Corticocancellous rib graft harvest mandates a second surgical site; however, it is relatively inconspicuous with low postoperative morbidity. Corticocancellous rib grafting is a safe and durable option for orbital reconstruction and should be considered for use in the pediatric patient with a growing facial skeleton.

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The Dilemma of Reconstructive Material Choice for Orbital Floor Fracture: A Narrative Review

Medicines ◽

10.3390/medicines9010006 ◽

2022 ◽

Vol 9 (1) ◽

pp. 6

Author(s):

Akash Sivam ◽

Natalie Enninghorst

Keyword(s):

Disease Transmission ◽

Narrative Review ◽

Orbital Floor ◽

Alloplastic Materials ◽

Complex Anatomy ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Material Choice ◽

Properties Of Materials ◽

Catastrophic Disease

The aim of this study is to present a narrative review of the properties of materials currently used for orbital floor reconstruction. Orbital floor fractures, due to their complex anatomy, physiology, and aesthetic concerns, pose complexities regarding management. Since the 1950s, a myriad of materials has been used to reconstruct orbital floor fractures. This narrative review synthesises the findings of literature retrieved from search of PubMed, Web of Science, and Google Scholar databases. This narrative review was conducted of 66 studies on reconstructive materials. Ideal material properties are that they are resorbable, osteoconductive, resistant to infection, minimally reactive, do not induce capsule formation, allow for bony ingrowth, are cheap, and readily available. Autologous implants provide reliable, lifelong, and biocompatible material choices. Allogenic materials pose a threat of catastrophic disease transmission. Newer alloplastic materials have gained popularity. Consideration must be made when deliberating the use of permanent alloplastic materials that are a foreign body with potential body interactions, or the use of resorbable alloplastic materials failing to provide adequate support for orbital contents. It is vital that surgeons have an appropriate knowledge of materials so that they are used appropriately and reduce the risks of complications.

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Surgical Approach to Orbital Floor Fractures: Comparing Complication Rates Between Subciliary and Subconjunctival Approaches

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520904893 ◽

2020 ◽

Vol 13 (1) ◽

pp. 45-48

Author(s):

Joel A. Bronstein ◽

William J. Bruce ◽

Fadi Bakhos ◽

Dalia Ishaq ◽

Cara J. Joyce ◽

...

Keyword(s):

Surgical Approach ◽

Complication Rate ◽

Patient Characteristics ◽

Orbital Floor ◽

Study Patient ◽

Complication Rates ◽

Postoperative Complication Rate ◽

Corneal Injury ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction

Background: There are multiple approaches to repairing orbital floor fractures. This study compares the postoperative complications of the subciliary and transconjunctival approaches. Methods: The electronic medical records from 2 hospitals were screened for CPT codes associated with orbital floor reconstruction. A total of 184 patients were identified and included in the study. Patient characteristics and complications were compared by surgical approach. Results: Of the 184 patients, 82 (44.6%) were in the subciliary group and 102 (55.4%) were in the transconjunctival group. The overall postoperative complication rate was 25.5%. The most common of these were diplopia (11.4%), corneal injury (7.1%), proptosis (5.4%), and enopthalmos (4.9%). The complication rate was not statistically significant between the 2 groups. Conclusion: Subciliary and transconjunctival approaches to orbital floor repair are equally safe. This study is limited by a smaller sample size, and a larger study will likely be necessary to fully address this question.

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Mydriasis during Orbital Floor Fracture Reconstruction: A Novel Diagnostic and Treatment Algorithm

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0030-1268517 ◽

2010 ◽

Vol 3 (4) ◽

pp. 209-216 ◽

Cited By ~ 6

Author(s):

Matthew S. Yeo ◽

Radwan Al-Mousa ◽

Gangadhara Sundar ◽

Thiam Chye Lim

Keyword(s):

Systematic Approach ◽

Preoperative Evaluation ◽

Treatment Algorithm ◽

Review Article ◽

Orbital Floor ◽

Facial Skeleton ◽

Orbital Floor Fracture ◽

Orbital Floor Fractures ◽

Common Causes ◽

The Common

Orbital floor fractures are the most commonly encountered traumatic fractures in the facial skeleton. Mydriasis that is detected during orbital floor fracture reconstruction may cause significant distress to surgeons, as it may be associated with sinister events such as visual loss. It is not an uncommon problem; previous studies have shown the incidence of mydriasis to be 2.1%. The combination of careful preoperative evaluation and planning, as well as specific intraoperative investigations when mydriasis is encountered, can be immensely valuable in allaying surgeons’ anxiety during orbital floor fracture reconstruction. In this review article, the authors discuss the common causes of mydriasis and present a novel systematic approach to its diagnostic evaluation devised by our unit that has been successfully implemented since 2008.

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Blowout Fracture in a 3-Year-Old

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0033-1333880 ◽

2013 ◽

Vol 6 (2) ◽

pp. 133-136 ◽

Cited By ~ 1

Author(s):

Britt I. Pluijmers ◽

Maarten J. Koudstaal ◽

Dion Paridaens ◽

Karel G.H. van der Wal

Keyword(s):

Young Children ◽

Surgical Planning ◽

Clinical Symptoms ◽

Orbital Floor ◽

Conservative Approach ◽

Transconjunctival Approach ◽

Blowout Fracture ◽

Fractures In Children ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction

A 3-year-old patient was referred to the oral and maxillofacial department with a fracture of the orbital floor. Due to the lack of clinical symptoms, a conservative approach was chosen. After 3 weeks, an enophthalmos developed. The orbital floor reconstruction was successfully performed through a transconjunctival approach. This case highlights the rarity of pure blowout fractures in young children. The specific presentation and diagnostics of orbital floor fractures in children and the related surgical planning and intervention are discussed.

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Orbital Adherence Syndrome following the Use of Titanium Precontoured Orbital Mesh for the Reconstruction of Posttraumatic Orbital Floor Defects

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0036-1584398 ◽

2017 ◽

Vol 10 (1) ◽

pp. 77-83 ◽

Cited By ~ 2

Author(s):

Geraldine Hwee Ping Lee ◽

Samuel Yew Ming Ho

Keyword(s):

Surgical Intervention ◽

Orbital Floor ◽

Titanium Mesh ◽

Orbital Trauma ◽

Orbital Reconstruction ◽

Smooth Interface ◽

Initial Surgery ◽

Patient Reported ◽

Orbital Floor Reconstruction ◽

Orbital Blowout Fractures

Orbital blowout fractures are a common occurrence following orbital trauma. Depending on the size of the defect and the contents that have herniated or incarcerated, possible sequelae include enophthalmos, diplopia, dystopia, and entrapment. Surgical intervention aims to prevent or alleviate this through the use of a bone graft or an alloplastic implant to reconstitute the continuity of the orbit. However, in doing so, the implant itself may result in the unexpected adherence of the periorbita, resulting in orbital adherence syndrome. We present two cases of orbital adherence syndrome following the use of titanium mesh for orbital floor reconstruction. In both cases, we also delineate the management of this syndrome. Our first patient reported good recovery after surgical intervention to relieve the tethering to the titanium mesh and subsequent placement of a smooth interface implant. The other patient was managed nonsurgically with resolution of symptoms. We highlight possible signs that might suggest the need for early surgical intervention. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery.

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ORBITAL FLOOR RECONSTRUCTION WITH TRANS-ANTRAL APPROACH USING ENDOSCOPE

UNIVERSITY JOURNAL OF DENTAL SCIENCES ◽

10.21276/ujds.2020.6.1.10 ◽

2020 ◽

Vol 6 (1) ◽

pp. 40-42

Author(s):

RISHABH GIRI ◽

Vikas Kunwar Singh ◽

Ruchika Tiwari ◽

Gaurang Thanvi

Keyword(s):

Posterior Part ◽

Good Alternative ◽

Conventional Approach ◽

Orbital Floor ◽

Treatment Modalities ◽

Orbital Fractures ◽

Blowout Fracture ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Endoscopic Assistance

Background and objective: Orbital floor fractures are very common in current day to day scenario. Till date different treatment modalities have been tried to reconstruct the orbital fractures. Conventionally various transorbital approaches have been used. But in cases where there is involvement of posterior part of orbit there is drawback of incomplete accessibility. To overcome this endoscopic assistance tends to get mandatory through trans-antral approach for better visualization, providing a good alternative to conventional approach. Case Report: A 55-year-old male patient with pure blowout fracture along with persistent diplopia and enophthalmos was operated with sub tarsal approach along with trans antral approach using endoscope. Result: The post-surgical results were satisfactory in respect to correction of diplopia and enophthalmos. Conclusion: Conventional approach assisted with endoscope provides a new method of managing Orbital floor fractures improving treatment outcomes.

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ORBITAL FLOOR RECONSTRUCTION WITH TITANIUM MESH;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2152 ◽

2014 ◽

Vol 21 (03) ◽

pp. 575-579

Author(s):

Muhammad Usman Khalid ◽

Arshad Mahmood Malik ◽

Omer Sefvan Janjua

Keyword(s):

Study Design ◽

Complication Rate ◽

Maxillofacial Surgery ◽

Male Gender ◽

Orbital Floor ◽

Titanium Mesh ◽

No Donor ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Infraorbital Rim

Objective: To determine the outcome of orbital floor reconstruction with titaniummesh in terms of diplopia, enophthalmos, dystopia and infection etc. Study design: Descriptivecase series. Place & duration of study: Department of Oral & Maxillofacial Surgery, PunjabMedical College / Allied Hospital Faisalabad. One and Half year from 01-10-12 to 31-03-14.Material and Method: Twenty two patients clinically and radiographically having defect in theorbital floor due to trauma were included in the study. Titanium mesh was used to reconstruct theorbital floor through infraorbital rim incision and secured in place with 5mm micro screws. Thevariables to be analyzed were diplopia, enophthalmos, orbital dystopia and infection. Results: Inour study male gender predominates over female 20/22. Mean age of patients is 29.36 years ±5.21. Diplopia persisted in 2/10 (20%) patients. Enophthalmos persisted in 7/18 (38.8%) patients.dystopia persisted in ¼ (25%) patients. Infection didn’t develop in any of our patient (0%). Visualacuity was not affected in any of the patient (0%). Conclusions: Titanium mesh is a suitablematerial for reconstruction of orbital floor fractures with little complication rate and no donor sitemorbidity.

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Teflon prosthesis in orbital floor fracture

Canadian Journal of Plastic Surgery ◽

10.1177/229255039400200110 ◽

1994 ◽

Vol 2 (1) ◽

pp. 32-34 ◽

Cited By ~ 1

Author(s):

Patrick G Harris ◽

Roger-Paul Delorme ◽

Roland Charbonneau ◽

Hugo Ciaburro ◽

Gilles Frenette

Keyword(s):

Operative Time ◽

Orbital Floor ◽

Operative Morbidity ◽

Recommended Treatment ◽

Orbital Floor Fractures ◽

Orbital Floor Reconstruction ◽

Primary Bone ◽

The Mean ◽

Panfacial Fractures ◽

Zygomatic Fractures

Primary bone grafting is the recommended treatment for orbital floor fractures with bone defects, but this technique has a greater operative morbidity than the simpler use of the Teflon prosthesis. This study evaluates the use of the Teflon prosthesis. In 9 years, 110 patients with 115 orbital floor fractures were treated with Teflon prostheses. Of those, 90 patients had only orbital floor or orbito-zygomatic fractures and 20 had panfacial fractures. The mean operative time was 87 mins. Seventy-seven patients had good results. Complications included diplopia, ectropion, enophthalmia and palpable prosthesis. Seven prostheses required removal between three and 11 months postoperatively. No prosthesis became infected. Orbital floor reconstruction with a Teflon prosthesis is a relatively simple and short procedure associated with a low morbidity, giving good results except in cases of severe floor defects.

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Relative Difference in Orbital Volume as an Indication for Surgical Reconstruction in Isolated Orbital Floor Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0031-1286117 ◽

2011 ◽

Vol 4 (4) ◽

pp. 203-211 ◽

Cited By ~ 23

Author(s):

Babak Alinasab ◽

Mats O. Beckman ◽

Tony Pansell ◽

Saber Abdi ◽

Anders H. Westermark ◽

...

Keyword(s):

Relative Difference ◽

Statistical Correlation ◽

Relative Volume ◽

Orbital Floor ◽

Surgical Reconstruction ◽

Facial Skeleton ◽

Nonsurgical Management ◽

Orbital Floor Fractures ◽

Orbital Tissue ◽

Orbital Content

In orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. In this study, we evaluated whether a relative change in volume would function as an indicator for surgical versus nonsurgical treatment of orbital floor fractures. This was a follow-up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. Patients were contacted by regular mail and invited to have a clinical eye examination. The volume of the orbital content was calculated digitally from the patients’ computed tomography scans at the time of their injury. Eighteen subjects with no facial skeleton fracture were included for reference of orbital content volumes. Five of 23 patients showed 2 to 4 mm of enophthalmos, and only three of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmos. No statistical correlation supporting the supposition that 1 mL of herniated orbital content would result in 1 mm of enophthalmos was found. The relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmos is unclear.

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