CLINICAL AND RADIOGRAPHIC EVALUATION OF THE USE OF ANTERO-LATERAL WALL OF MAXILLARY SINUS FOR RECONSTRUCTION OF ORBITAL FLOOR DEFECT

Abstract

INTRODUCTION: The orbital floor fracture results in disruption of bony continuity, enophtalmos, diplopia and herniation of orbital content which lead to a restriction in eye movement. Auotogenous bone graft remains as the gold standard for reconstruction of orbital floor defects, the anterolateral wall of maxillary sinus is considered as one of the donor site used in the reconstruction of the orbital floor defects, which has many advantages such as biocompatibility, strength, vascularization and has no immune reaction. In addition, its contour fits exactly the orbital floor defect, a simple harvesting technique from an intraoral donor site which minimizes its morbidity. OBJECTIVE: We aimed in the present study to evaluate the use of anterolateral wall of maxillary sinus clinically and radiographically in the reconstruction of orbital floor defects in ten patients. MATERIALS AND METHODS: All operated patients had more or less one or more signs and symptoms of orbital floor fracture as diplopia, enophthalmos, limitation of eye movements and progressive infraorbital nerve hypoesthesia. The graft harvested with peizosurgery from contralateral side of the fracture, the donor site is covered by a collagen membrane to prevent soft tissue infiltration. The harvested bone graft is adapted to the defect with no other means of fixation. The follow-up schedule was 3 days postoperatively then once weekly for two weeks and then monthly for 3 months. RESULTS: All patients with preoperative diplopia had significant improvement postoperatively. 8 patients out of 9 with preoperative ocular restriction had improvement in the postoperative follow up visits. 6 patients with preoperative enophthalmos showed improvement in the postoperative follow up visits. 7 patients with infra orbital nerve paresthesia preoperatively, all of them showed improvement in the follow up visits. CONCLUSION: The study concluded that the anterolateral wall of the maxillary sinus is a suitable material for orbital floor reconstruction, especially in cases of small to medium defects (< 3 cm2).