Repair Of Orbital Wall Defects Research Articles

Orbital Osteoma

This study reviews the clinical presentation and management of 11 cases of sino-orbital osteoma. The medical records of patients with primary (originating from orbital bone) and secondary (originating from the paranasal sinuses) orbital osteoma from the academic practices of 4 surgeons (A.V.C., M.J.L., P.J.D., V.D.D.) were reviewed for clinical presentation and course, pathologic study, and radiologic reports. A Medline search of English-language literature on orbital osteomas was conducted for comparison with these findings. Eleven cases of primary (1) and secondary (10) orbital osteoma were reviewed, with a mean follow up of 16 months. Seven patients were women. Ages ranged from 15-68 years, with a median of 40 years. Presenting complaints included slowly progressive globe displacement, palpable bony nodule, pain, and diplopia. Surgery was performed in 10 cases. Surgical approach varied according to location and size of each lesion and was performed in combination with otolaryngology and neurosurgery services as needed. Reconstruction included sculpting osteomatous bone to natural orbital contours, repair of orbital wall defects with implants, and obliteration of frontal sinus. Lesions demonstrated mixed compact, cancellous, and fibrous histologic subtypes. Osteomas are the most common tumor of the paranasal sinuses (noted in up to 3% of coronal CT images), but secondary extension in or primary involvement of the orbit is rare. A variety of surgical approaches led to successful outcomes in this series. Complete surgical removal is not always necessary, and partial sculpting may relieve symptoms and cause less surgical morbidity in selected cases.

Late-Onset Orbital Hematoma Secondary to Alloplastic Orbital Implant Mimicking Transient Ischemic Attacks

Alloplastic orbital implants are commonly used by surgeons in the repair of orbital wall defects. They are generally well tolerated, but they may cause late-onset complications. The authors present the case of a 65-year-old man with a history of left orbital floor fracture repair 25 years prior using a silicone orbital implant. He presented with a 1-year history of recurrent binocular vertical diplopia previously diagnosed as transient ischemic attacks. The patient subsequently presented with symptoms suggestive of orbital cellulitis, and after failure to respond to antibiotic therapy, he underwent surgical removal of the implant, revealing a large orbital hematoma. This case represents an unusual presentation of a known complication associated with orbital implant placement in a patient with previously diagnosed cerebrovascular disease as the cause of his neuroophthalmologic symptoms.

Repair of orbital wall defects using biocoral scaffolds combined with bone marrow stem cells enhanced by human bone morphogenetic protein-2 in a canine model

Repair of orbital bone defects caused by trauma, infection or cancer is a continuous challenge in reconstructive surgery. Few studies have reported the application of tissue engineering for the repair of orbital bone defects in large animal models. Thus, we investigated the effects of tissue-engineered bone enhanced by the human bone morphogenetic protein-2 (BMP2) on the repair of orbital wall defects in a canine model. Autologous bone marrow stromal cells (BMSCs) from 16 Beagle dogs were isolated and cultured in vitro. Passage 2 cells were transfected with adenovirus containing human BMP2 (adv-BMP2) and tissue-engineered bone was constructed using BMP2-expressing BMSCs seeded on a biocoral scaffold. Circular defects (12-mm diameter) created bilaterally in the canine medial orbital wall, were treated with one of the following: adv-BMP2-transfected BMSC/coral composite (group I, n=8), BMSC/coral composite (group II, n=8), biocoral alone (group III, n=8), or were left untreated (group IV, n=8). Four samples from each group were harvested at 12 and 24 weeks after surgery, and the volume and density of newly regenerated bone were determined by micro-computed tomographic (micro-CT) measurement. The rate of new bone deposition and regeneration was measured by tetracycline/calcein labeling and histomorphometric analysis. The results showed that a canine 12-mm circular orbital defect was a critical-sized defect, and the micro-CT and histomorphometry detection results indicated that the combined delivery of BMSCs and BMP2 (group I) resulted in the highest regenerative effects on orbital bone defects, compared to the other groups without BMP2. Biocoral scaffolds combined with BMSCs enhanced by BMP2 could improve the healing of critical-sized medial orbital wall defects in canines.

Reconstruction of Old Orbital Wall Fractures With Mandibular Outer Cortex

This study focused on using the mandibular outer cortex in the reconstruction of old orbital wall fractures. Old orbital wall fractures of 46 patients were reconstructed with the mandibular outer cortex. The surgical results were evaluated by performing clinical follow-up and by measuring the changes in the orbital volume. Donor-site complications were also evaluated. All patients had good aesthetic and functional results, with an accurate repair of orbital wall defects and the restoration of orbital volume. There were no obvious major donor-site complications. The mandibular outer cortex can be used for the reconstruction of old orbital wall fractures.

Repair of traumatic orbital wall defects with nasal septal cartilage: Report of five cases

Purpose This article reports the use of nasal septal cartilage for the repair of traumatic orbital wall defects. Patients and Methods Five patients with disruption of the orbital wall after facial trauma were included in this retrospective review. All of the patients underwent open reduction with internal fixation of the fractures as well as repair of the orbital wall defect with autogenous septal cartilage. Results Nasal septal cartilage was used in four cases of orbital floor defect and one case of orbital roof defect. All of the cases were successfully treated by restoration of the orbital wall continuity. Conclusion Nasal septal cartilage is a readily accessible autogenous material that can be easily harvested with minimal donor site morbidity, and it should be considered when an autogenous orbital implant is needed for the repair of a traumatic orbital wall defect.