KBB-Forum 2019 , Cilt 18, Sayı 2

COMPARISON OF PATIENT POST-OPERATIVE OUTCOMES OBTAINED WITH BIOMATERIALS USED FOR RECONSTRUCTION OF ORBITAL BLOW-OUT FRACTURES

Çiğdem DEMİROĞLU YAKUT 1, MD; Serdar DÜZGÜN 2, MD; Ramazan ERKIN ÜNLÜ 3, MD; Necip CİHAN HASÇİÇEK 4, MD;
1Acıbadem Ankara Hastanesi, Plastik, Rekonstrüktif ve Estetik Cerrahi, Ankara, Turkey
2Liv Hospital Ankara, Plastik, Rekonstrüktif ve Estetik Cerrahi, Ankara, Turkey
3SBÜ Ankara Numune Eğitim ve Araştırma Hastanesi, Plastik, Rekonstrüktif ve Estetik Cerrahi, Ankara, Turkey
4Özel Esentepe Hastanesi, Plastik,Rekonstrüktif ve Estetik Cerrahi, Bursa, Turkey Purpose: In the surgical treatment of orbital blow-out fractures, it is essential to restore the orbital volume by proper placement of a biomaterial that can adequately support the orbital content. Many autogenous and synthetic biomaterials have been recommended for this purpose. This study aims to compare postoperative results of 4 different biomaterials.

Materials and Method: 64 orbital floor fractures were reconstructed in 62 patients presenting to our clinic with maxillofacial trauma. For reconstruction of orbital floor defects, an iliac bone graft was used in 14 patients, a conchal cartilage graft was used in 19 patients, an ultra thin porous polyethylene implant was used in 15 patients and a titanium mesh was used in 16 patients.

Results: An implant extrusion was observed in 2 of 15 patients in whom a porous polyethylene implant was used. Two patients developed upper gaze limitation and vertical diplopia at this group. Two patients each from the groups with bone and cartilage grafts and one patient from the titanium mesh group had permanent vertical diplopia in extreme gazes. One patient in the titanium mesh group developed an infection that did not require implant excision.

Conclusion: In our study, the complication rate in the conchal cartilage graft and titanium mesh group was significantly lower than other biomaterials. Complications of porous polyethylene implant such as postoperative implant extrusion, enophthalmus persistence, permanent upward gaze restriction suggest that it is not an optimal biomaterial for orbital floor reconstruction. The iliac bone graft often causes donor area complications such as severe pain, hematoma and scar and prolongs the operation. For these reasons, in line with the results of our study; we believe that conchal cartilage graft is the most suitable biomaterial to use for orbital floor defects that are smaller than 4 cm2 and a titanium mesh implant is better for defects that are larger than 4 cm2. Keywords : Orbital blow-out fractures, conchal cartilage graft, titanium mesh implant, enophthalmos