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

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.

Role of orthoptics and scoring system for orbital floor blowout fracture: surgical or conservative treatment

AIM: To assess the role of orthoptics in referring patients with orbital floor blowout fracture (OFBF) for conservative or surgical treatment and based on the results, to propose a scoring system for such decision making. METHODS: A retrospective analysis of 69 patients with OFBF was performed (35 treated conservatively, 34 surgically). The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated, the factors with the highest significance for decision making were identified, and a scoring system proposed using Logistic regression. RESULTS: According to defined criteria, the treatment was unsuccessful in 2 (6%) surgically treated and only in one (3%) conservatively treated patient. The proposed scoring system includes the defect size and several values resulting from the orthoptic examination, the elevation of the eyebulb measured on Lancaster screen being the most significant. CONCLUSION: The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder (with or without binocular diplopia) in OFBF patients. The proposed scoring system could, following verification in a prospective study, become a valuable adjunctive tool.

Cone Beam CT Analysis of Haller Cells: Prevalence and Relationship with Orbital Floor Dehiscence

Background and aim: Haller cells arise from anterior ethmoid air cells and are located in the medial orbital floor, lateral to the maxillary infundibulum. The aim of this cross-sectional study was to determine the prevalence of the Haller cells and its relationship with orbital floor dehiscence on cone beam CT images. Materials and Methods CBCT images of 120 patients were interpreted in coronal plane for the presence of Haller cells and orbital floor dehiscence. The prevalence of Haller cell, presence of dehiscence, unilateral or bilateral frequency were assessed. In addition, the size were categorized in three groups of small, medium and large. Chi-square and Cochran-Mantel-Haenszel tests were used for statistical analysis of the data and p<0.05 was considered to be significant. Results A total of 51 male and 69 female with Mean±SD age of 38.84±68.14 were assessed. The overall prevalence of Haller cells was 56.7%, of which 44 (64.7%) were unilateral and 24 were bilateral (35.3%). The majority of the cells (70.7%) were seen in medium (2-4mm) sized. There was a significant association between Haller cells and orbital floor dehiscence (p=0.002). Conclusion The prevalence of Haller cells was remarkably high and presence of Haller cells was strongly associated with ipsilateral orbital floor dehiscence. Based on the findings of this study, CBCT can be useful in delineation of the bony anatomy of sinonasal complex.