An Examination of Posttraumatic, Postsurgical Orbital Deformities: Conclusions Drawn for Improvement of Primary Treatment

Abstract

A retrospective analysis was carried out on the records of 317 patients operated on by the senior author (S.A.W.) for orbital fractures between 1975 and 2007. Two hundred forty of the patients had been previously operated on elsewhere and required further correction (posttraumatic, postsurgical orbital deformity). A smaller group of patients (n = 77) were operated on primarily. The two groups were not, of course, similar, because the posttraumatic, postsurgical orbital deformity group had been operated on by a variety of surgeons with varying levels of experience and ability, and the group of patients operated on primarily had a larger percentage of fractures in the pediatric age group, because of the practice being partially based in a children's hospital, and a larger percentage of severe, compound orbital injuries, because of statewide referrals. Nevertheless, a number of causes for reoperation seen in the posttraumatic, postsurgical orbital deformity group were not seen in the primarily operated group. These included lower eyelid retraction attributable to use of the subciliary incision, displacement and extrusion of alloplastic materials, and fixation of fractures in a nonreduced position. These differences validate, in the authors' opinion, the application of the basic principles of craniofacial reconstruction set forth by Paul Tessier, listed in the text, to both the primary and secondary treatment of posttraumatic orbital deformities.

Evaluation of Skull Strength following Parietal Bone Graft Harvest

“…In particular, hematomas may be associated with severe sequelae. 8 In children, Wolfe et al 5 recommend repositioning the outer table after harvesting. In professional football players, they recommend selecting another donor site if the graft exceeds half the total thickness of the parietal bone.…”

“…1,2 Membranous bone undergoes less resorption than enchondral bone. 3 This is why it is preferred in several situations, including preimplant procedures, 4 orbital surgery, 5 facial deformities, and facial cosmetic surgery. 6,7 Removing bone from the outer table decreases thickness of the calvaria.…”

An Evidence-Based Approach to Zygomatic Fractures

“…These differences validate the application of the basic principles of craniofacial reconstruction set forth by Paul Tessier for these posttraumatic orbital deformities to achieve the best overall results (Therapy: Level IV Evidence). 24 Although plate-and-screw fixation is the mainstay for zygomatic and orbital fractures, Yonehara et al recommend that fixation of the inferior orbital rim with miniplates or microplates should be avoided because of postoperative scarring and sensory disturbances caused by a subciliary incision. They confirm the status of the inferior orbital rim reduction by palpation.…”

Resistance of the sheep skull after a monocortical cranial graft harvest

“…Autologous cranial bone grafts harvested from the outer table of the parietal bone are commonly used in preimplant surgery for augmentation of the alveolar ridge (Baccar et al, 2005;Gutta and Waite, 2008;Iizuka et al, 2004), sinus floor elevation (Crespi et al, 2007;Le Lorc'h-Bukiet et al, 2005) and for other craniomaxillo-facial reconstructions (Emsen and Benlier, 2008;Himy et al, 2009;Siddique and Mathog, 2002;Wolfe et al, 2008) Removing bone from the parietal area decreases the thickness of the calvarium and may potentially affect the impact strength of the donor site. In a recent study, Torres-Lagares et al highlighted the low and stable remodelling in the parietal bone (Torres-Lagares et al, 2010).…”