Bone and cartilage wedge technique in posttraumatic enophthalmos treatment.
OBJECTIVE
To evaluate a new surgical method, using calvarial bone graft combined with a wedge of irradiated homologous costal cartilage, for the revision repair of posttraumatic enophthalmos.


METHODS
This retrospective study was performed from January 1, 2003, through December 31, 2007. Eight patients were diagnosed as having unilateral posttraumatic enophthalmos. All the patients had previously undergone insufficient primary repair of their orbital fractures. In the revision surgery a calvarial bone graft was placed in the area of the defect using a transconjunctival approach. In combination with this technique, a wedge of irradiated rib cartilage was placed on the bone graft behind the globe. Patients were assessed preoperatively and postoperatively by ophthalmologists and maxillofacial surgeons. Standard follow-up examinations were performed at 2 and 4 weeks and at 3 and 6 months after surgery. Computed tomographic scans were obtained preoperatively and postoperatively from all patients.


RESULTS
For all 8 corrected orbits, favorable cosmetic results were obtained regarding the position of the globe. The mean preoperative Hertel exophthalmometer showed a difference of 3.1 mm and 0.7 mm postoperatively. Improvement of ocular motility and reduction of diplopia were achieved in only 1 patient; in the others, motility and diplopia remained unchanged. No postoperative complications were observed.


CONCLUSIONS
The bone and cartilage wedge technique seems to be a useful surgical technique for the cosmetic correction of posttraumatic enophthalmos.
Lieger
Olivier
O
Department of Cranio-Maxillofacial Surgery, Hospital Lucerne, Lucerne, Switzerland. olivier.lieger@ksl.ch
Zix
Jürgen
J
Kruse
Astrid
A
Goldblum
David
D
Iizuka
Tateyuki
T
D000328:Adult; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation; D004172:Diplopia / Q000000981:diagnostic imaging / Q000601:surgery; D015841:Enophthalmos / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult