Reconstruction of internal orbital wall fracture with iliac crest free bone graft: clinical, computed tomography, and magnetic resonance imaging follow-up study.
BACKGROUND
The purpose of this study was to clinically and radiologically assess the outcome of internal orbital reconstruction with an iliac bone graft.


METHODS
Twenty-four consecutive patients with unilateral orbital wall fractures were enrolled in this prospective study. A medial cortical wall from the anterior ilium was used for reconstruction. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and magnetic resonance imaging were used to observe graft posture, bone defects, and intraorbital soft-tissue changes.


RESULTS
Most fractures (46 percent) were pure orbital floor fractures. The mean follow-up was 7.8 months. One patient with medial wall and floor fractures required reoperation because of insufficient bone graft. At the last follow-up, this was the only patient (4 percent) with both enophthalmos (2 mm) and hypophthalmos (3 mm). Five patients (21 percent) had hypophthalmos (> 1 mm) at the end of the study. Resorption and remodeling were detected in all grafts, but no grafts were totally resorbed. Sagittal or coronal bone graft postures were assessed as good in 18 orbits (75 percent). Bone defects (> 10 mm) at reconstructed areas were detected in 13 orbits (54 percent). Scar tissue was observed only in three reconstructed orbits (13 percent). Diplopia in central field of vision was registered in seven patients preoperatively but in none at the end of the study.


CONCLUSIONS
The resorption rate was high, but most of it was advantageous remodeling. Overall outcome was good. Secondary operations led to poor outcomes. Thin computed tomography and magnetic resonance imaging sections (< or = 2 mm) are needed to evaluate accurately bone graft placement and posture and orbital volume.
Kontio
Risto K
RK
Helsinki, Finland From the Departments of Oral and Maxillofacial Surgery and Radiology, Helsinki University Central Hospital, and Department of Oral and Maxillofacial Surgery, Helsinki University.
Laine
Pekka
P
Salo
Antero
A
Paukku
Pertti
P
Lindqvist
Christian
C
Suuronen
Riitta
R
D000328:Adult; D016723:Bone Remodeling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous