Traumatic Orbital Floor Fractures: Repair With Autogenous Bone Grafts in a Tertiary Trauma Center

Abstract

To evaluate the outcome of autologous bone grafts in the reconstruction of orbital floor fractures. A retrospective interventional case series was performed at a tertiary trauma center. All patients with traumatic orbital floor fractures that had been reconstructed using calvarial or iliac autogenous bone grafts from August 2006 to January 2010 were included in the present study. The operations were performed by the same team of maxillofacial and oculoplastic surgeons. The patients were evaluated pre- and postoperatively for the presence of enophthalmus and diplopia. The surgical technique was tailored to best fit the patient's clinical characteristics, with attention to the cosmetic and functional outcomes and the preferred use of a sutureless transconjunctival technique, when applicable. The main outcome measures were residual enophthalmus, diplopia, and the complication rate. A total of 16 patients (11 males and 5 females), with an average age of 34.4 years, underwent orbital floor reconstruction using an autologous bone graft. Calvarial and iliac bone grafts were used in 11 and 5 patients, respectively. A transconjunctival approach was applied in 10 patients. All patients achieved good cosmetic and functional outcomes, with improvement in enophthalmus. Three patients had residual diplopia postoperatively that was probably due to traumatic muscular injury. No significant perioperative or long-term complications were noted during a mean follow-up of 12.5 months. Reconstruction of orbital floor fractures after trauma using autologous bone grafts is safe and associated with a low rate of complications. Combining the appropriate surgical approach with multidisciplinary teamwork results in excellent cosmetic and functional outcomes and allows for efficient and comprehensive postoperative management.