Bilateral Orbital Reconstruction With Autologous Bone Graft After Gunshot Wound to Upper Midface.

Adam Bicak,Kristopher M Day,Jessica Hale

doi:10.7759/cureus.13611

Adam Bicak, Kristopher M Day + Show 1 more

Open Access

https://doi.org/10.7759/cureus.13611

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Abstract

Ballistic maxillofacial injuries are highly destructive, producing significant morbidity and mortality. Survivors’ defects pose unique reconstructive challenges, such as loss of periorbital bone stock in upper midface injuries. While orbital reconstruction has transitioned from primarily autologous grafts to alloplastic implants, ballistic trauma remains a niche that warrants the use of autologous bone equally with alloplastic materials. We report a case of an upper midface gunshot wound in a 20-year-old male producing bilateral comminuted medial orbital wall fractures. Reconstruction utilized bilateral split-thickness calvarial bone grafts through preseptal transcaruncular transconjunctival incisions. This case illustrates the utility of autologous bone grafts in the setting of lost periorbital bone stock and minimizing foreign body in surgical fields at high risk of infection or complication. Further studies are necessary to refine the indications for autologous bone grafting and its benefit relative to alloplastic implants in ballistic periorbital trauma.

Highlights

Orbital fractures are a common encounter for plastic and craniofacial surgeons, comprising 16% of all facial fractures [1]
We describe a case of complex periorbital ballistic trauma with comminuted bilateral medial wall fractures with loss of bone stock
We report a case of an upper midface gunshot wound in a 20-year-old male producing bilateral, highly-comminuted medial orbital wall fractures

Summary

Introduction

Orbital fractures are a common encounter for plastic and craniofacial surgeons, comprising 16% of all facial fractures [1]. Despite an evolution toward alloplastic implants, there may still be specific clinical indications for orbital reconstruction with autologous bone grafts In this case report, we present a 20-year-old male with a gunshot wound to the upper midface causing bilateral medial wall comminuted fractures, who subsequently underwent repair with split-thickness calvarial bone grafts through a preseptal transcaruncular transconjunctival approach. There was a gunshot wound to the right medial canthal periorbital region, which was associated with left eyelid ptosis and bilateral periorbital ecchymosis and swelling He had no evidence of entrapment, enophthalmos, or direct globe trauma. CT scans were obtained on postoperative day 2 (Figure 4) and shown to have good orbital symmetry with defects repaired bilaterally, restoration of bone stock, and without periorbital tissue herniation or impingement He continued preoperative antibiotics following surgery due to concomitant lobar pneumonia. He continues to do well without complications one year postoperatively

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Disclosures

Burnstine MA