Comparative Study between Conchal Cartilage Grafts and Split Rib Grafts in the Reconstruction of Orbital Floor Fractures

Abstract

Background: Orbital floor fractures always represent a challenge for reconstruction. Various techniques for treatment had evolved over the past years, each with their strengths and weaknesses. The main aim of surgical repair is to relocate herniated orbital tissue and fat back into the orbit restoring both the function and aesthetic aspect. Reconstruction of orbital floor can be performed using various types of materials, either autologous as rib grafts or cartilage grafts or alloplastic as titanium mesh. Aim of the Study:The aim of this study is to compare the results of using autologous cartilage grafts with those of split rib graft in small posttraumatic orbital floor defects reconstruction.Patients and Methods: 30 patients with orbital floor defects due to maxillofacial trauma. They were divided into 2 groups according to the technique of reconstruction: Group 1: 15 patients who had reconstruction by onlay split rib grafts Group 2: 15 patients who had reconstruction by conchal cartilage grafts, using either unilateral or sutured bilateral conchal cartilage grafts in large defects. Both methods were analyzed clinically and radiologically and were compared as regards, their advantages and disadvantages Postoperative assessment using CT scan were used.Results: With the conchal cartilage grafts, the results were more favorable with statistically significant decrease in complications.Conclusion: Reconstruction of orbital floor fractures using conchal cartilage grafts represents a safe and reliable method of reconstruction with less complications.

A systematic literature review and narrative synthesis on the use of autologous cartilage in the repair of orbital fractures

“…These articles were filtered for relevance and duplication, resulting in 46 articles. A full-text assessment was then performed, which reduced the number of articles to 16 articles 13 , 14 , 23 – 36 . With regards to quality of evidence, all of the studies which were eligible for inclusion were considered to be of moderate quality.…”

“…In orbital defects between 1.5 and 2 cm 2 , Mohamed et al . 36 found that bilateral sutured conchal cartilages helped overcome some of the problems which may arise from such large defects.…”

“…Orbital fractures were first described by MacKenzie and Lang in 1844 37 . Since then, there have been numerous studies performed which have investigated the timing and surgical approach of this presentation, however the criteria for the surgical management of orbital fractures still remains a controversial topic 36 . Currently, three general guidelines are agreed upon that if present, may be an indication to early surgical intervention.…”

Retrospective Analysis of the Outcomes in Orbital Floor Fractures: Guidelines for Better Strategic Management

“…Reconstruction of orbital floor and restoration of volume can be performed using various types of materials, either autologous as bone grafts, cartilage grafts, and fat graft or alloplastic as titanium mesh [20,21]. The most used material was titanium, has the highest tensile strength despite easily bending, and it is compatible with radiographic imaging with a low risk of infection [21,22].…”