Repair of Orbital Blow‐out Fractures With Nasoseptal Cartilage

Abstract

The goals of reconstruction in orbital blow-out fractures are to restore floor continuity, provide support of orbital contents, and prevent fibrosis of soft tissues. Although ease of use has popularized alloplasts, autogenous material provides greater biocompatibility and results in low rates of infection, extrusion, and migration. Nasoseptal cartilage is an easily accessible, abundant, autogenous source that provides support to the orbital floor and minimal donor site morbidity. Thirteen patients who presented with orbital blow-out fractures underwent reconstruction with nasoseptal cartilage. Follow-up at 3 months to 4 years shows one patient with persistent manifest enophthalmos requiring further augmentation. There were no recipient or donor site complications. Nasoseptal cartilage is an underutilized and superior material for reconstruction of orbital blow-out fractures.

Repair of Traumatic Orbital Wall Defects Using Conchal Cartilage

“…As an autogenic material, they also have other advantages, such as biocompatibility and lower complication rates, in addition to their superior qualities. 8 Kraus et al have also reported successful results in this field using septal cartilage in children 19 and adults. 18 Conchal cartilage, which possesses characteristics and advantages similar to those of cartilage grafts, was used formerly in orbital reconstruction.…”

“…Lai et al, 8 who proposed the superiority of autogenic materials, have also reported favorable results in the repair of orbital blowout fractures in which they have used nasoseptal cartilage. The authors report that nasoseptal cartilage, although it is rarely used in this field, possesses the advantages of having a greater survival rate and a lower rate of resorption because of its anaerobic metabolism, because of its being close to the surgical location to harvest, and because of its having minimal cosmetic and functional morbidity.…”

“…16 However, these complications were not reported in the series that used autogenous material, such as nasoseptal cartilage, in orbital reconstruction. 8,18,19 In addition, sliced costal cartilage use was sufficiently reported without any graft-related complication in the studies in which the grafts were used for intraorbital volume replacement in the treatment of enophthalmos as a late complication of orbital fractures. 20,21 Allogeneic materials have also been used successfully in the treatment of defective orbital wall fractures without the above-mentioned complications 22,23 ; in contrast, their use is associated with the risk of disease.…”

Materials to facilitate orbital reconstruction and soft tissue filling in posttraumatic orbital deformaties

“…The nasal septum is advantageous owing to the rapid harvest time and the minimal cosmetic and functional morbidity. [17,18] Bayat et al [19] performed a randomized clinical trial and found a superior effect for nasal cartilage compared to conchal cartilage with respect to the incidence of enophthalmos at the 3-6 months follow-up point. Whereas, the autologous cartilage still cannot avoid donor site morbidity and is limited in quantity.…”

Controversies in orbital reconstruction—III. Biomaterials for orbital reconstruction: a review with clinical recommendations

“…14 The nasal septum is particularly advantageous because of the rapid harvest time and the minimal cosmetic and functional morbidity. 15 Bayat et al 16 performed a randomized clinical trial (RCT) and found a superior effect for nasal cartilage versus conchal cartilage with respect to the occurrence of enophthalmos at the 3-6-month follow-up. A second RCT found no significant differences in the clinical outcomes of orbital fractures repaired with either a cartilage graft or an absorbable polyacid co-polymer.…”