Effectiveness of a nasoseptal cartilaginous graft for repairing traumatic fractures of the inferior orbital wall

Abstract

The goals of reconstruction after an orbital fracture are to restore the continuity of the floor, provide support for the orbital contents, and prevent fibrosis of the soft tissues. Nasoseptal cartilage is an easily accessible, abundant, and autogenous source that supports the orbital floor and gives minimal donor site morbidity. We evaluated the effectiveness of nasoseptal cartilage for repairing traumatic defects of the orbital floor. Autogenous nasoseptal cartilage was used in 20 patients. Presence or absence of diplopia, enophthalmos, paraesthesia of the infraorbital nerve, dystopia, range of covering of the defect by nasoseptal cartilage, complications at the recipient and donor sites, resorption of the graft, and ocular mobility disorders were recorded. Entrapment of orbital tissues, a large orbital defect (more than 50% of orbital floor or more than 8 mm), or defects of the orbital floor with involvement of other fractures of the zygomaticofrontal complex are indications for exploration of the orbit. In one case after 24 months, the surgical field was explored for direct evaluation of the efficacy of the graft. All patients were treated successfully by restoration of the continuity of the orbital floor. Six months to 2 years follow up showed only one patient with postoperative enophthalmos. There was no donor site morbidity, and no grafts became infected or extruded. The nasoseptal graft was completely covered with underlying tissue. Nasoseptal cartilage is readily accessible autogenous tissue that should be considered when an autogenous graft is needed for reconstruction of a defect of the orbital floor.