Reconstruction of the orbital floor with sheets of autogenous iliac cancellous bone.
OBJECTIVE
Various autografts and synthetic materials such as titanium plates have been used for orbital floor reconstruction; however, no consensus on reconstruction methods has been reached. We have used iliac cancellous bone for this reconstruction with good results.


METHODS
Patients (n = 101) enrolled in this study underwent orbital floor reconstruction of pure blowout fracture with an approximate 1 mm thinned and trimmed iliac cancellous bone without fixation of the graft. The results were assessed by CT; diplopia exceeding an angle of 45 degrees was evaluated as a poor outcome.


RESULTS
Postoperatively, diplopia appeared in 15 patients and disappeared in 86 patients. At 6-month follow-up, CT showed that the morphology of the orbit was well maintained and no shedding or improper positioning of the grafted bone was observed in any of the patients. Moreover, CT images demonstrated ossification of the transplanted bone graft.


CONCLUSIONS
The method encompassing the use of the medulla of the iliac bone has several merits: 1) the graft bone is sufficiently pliable and flexible to fit the gently curving orbital floor; 2) being soft, it is easy to cut. Furthermore, no complication attributable to its fragility is observed at short- and long-term follow-up. The 1 mm thin medullar bone graft derives its robustness from its beamed structure. We consider the medulla of the iliac bone fitting autosomal material for the reconstruction of the orbital floor.
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan. sakakibara@moon.odn.ne.jp
Shunsuke
S
Sakakibara
Kazunobu
K
Hashikawa
Hiroto
H
Terashi
Shinya
S
Tahara
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D017102:Fracture Healing; D006801:Humans; D007085:Ilium; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D009917:Orbital Fractures / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D014182:Transplantation, Autologous; D055815:Young Adult