Autogenous Ramus Graft Versus Alloplastic Titanium Mesh in Orbital Floor Reconstruction

Document Type : Original Article

Authors

1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 Department of Biostatistics, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Background and Objective: The management of orbital fractures is one of the most challenging area in facial trauma. No consensus exists on the choice of implants to be used for orbital floor reconstruction. Here we present the short term results of the outcome of autogenous ramus graft versus alloplastic materials in a randomized prospective clinical trial.
Subjects and Methods: A total of 22 patients with orbital floor fracture were entered in our study in two groups randomly. Patients of first group were treated by autograft of lateral cortex from mandibular ramus, and the patients of second group by titanium mesh as an alloplastic material. All patients were followed for 6 months and enophthalmos, diplopia, cheek paresthesia and infection rate were assessed.
Results: There were no significant differences between two groups in respect to enophthalmos(p > 0.8), diplopia, vertical dystopia (p > 0.5) cheek paresthesia and infection rate. Both mandibular ramus and alloplastic titanium mesh can be used in orbital floor reconstruction regardless of size of defect.
Conclusion: Both mandibular ramus autograft and alloplastic titanium mesh are reliable and successful techniques to address the orbital floor fracture. Ramus region provides an appropriate volume of bone with vascularization, low extrusion rate and so inert, but donor site morbidity and more time-consuming are disadvantages. Highly biocompatibility, minimal resorption potential,     well-recognized osseointegration and contouring, no donor site morbidity and less time consuming are advantages of titanium mesh; but the risk of graft extrusion or anticipated difficulty while insertion and removing the material if needed because of fibrous ingrowth and also additional cost required ,are its drawbacks.
 

Keywords

References

 
1-Dawson RLG, Fordyce GL. Complex fractures of the middle third of the face: their early treatment. Br J Surg 1953 Nov; 41(167): 255-68.
2-Ellise E, El-Attar A, Moos KF. An analysis of 2067 cases of zygomatico-orbital fractures. J Oral Maxillofac Surg 1985Jun; 43(6):428.
3-Fujii N, Yamashiro M. Classification of malar complex fractures using CT. J Oral Maxillofac Surg 1983Sep; 41(9): 562-7.
4-Bite U, et al .Orbital volume measurements in enophthalmos using 3-D CT imaging. plast Reconstr Surg1985; 75:502.
5-Antonyshyn O, Gruss JS, Galbraith DJ, Hurwitz JJ. Complex orbital fractures: A critical analysis of immediate bone graft reconstruction. Ann Plast Surg1989Mar; 22(3): 220-3.
 
6-Al-Sukhun J, Lindqvist C. A  comparative  study  of  2  implants  used  to  repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-lactide LA70/30 plate . J Oral Maxillofac Surg 2006Jul; 64(7): 1038-48.
7-Sugar AW, Kuriakose M, Walshaw ND. Titanium mesh in orbital wall reconstruction. Int J Oral Maxillofac Surg 1992Jun; 21(3):140-4.
8-Potter JK, Ellis E. Biomaterials for the reconstruction of the internal orbit. J Oral Maxillofac Surg 2004Oct; 62(10): 1280-97.
9-Mass CS , Merwin GE, Wilson J, Frey MD, Maves MD. Comparison of biomaterials for facial bone augmentation. Arch Otol Head Neck Surg1990May; 116(5): 551-6.
10-Smith BR, Rajchel JL, Waite DE, Read L. Mandibular anatomy as it relates to rigid fixation of the sagittal ramus split osteotomy. J Oral Maxillofac Surg 1991Mar; 49(3): 222-6.
11-Dickinson JT, Jaquiss GW. Alloplastic implants. Otplaryngol Clin North Am1972Oct; 5(3): 481-500.
12-Evarts CM, Steffee AD, McMormack LJ. Investigation of canine tissue reaction to TFE-fluorocarbon resin to high density polyethylene, and to vitallium. Surg Res1970Feb; 10(2): 91-4.
13-Sargent LA, Fulks KD. Reconstruction of internal orbital fractures with vitallium mesh. Plast Reconstr Surg 1991Jul; 88(1): 31-8.
14-Rubin PAD, Shore JW. Complex orbital fracture repair using rigid fixation of the internal orbital skeleton. Ophthalmology1992Apr; 99(4): 553-9.
15-Banica B, Ene P, Vranceanu D, Ene R. Titanium performed implants in orbital floor reconsruction-case presentation, review of literature. Madica J Clin Med 2013Mar; 8(1): 34-9.
16-Wajih WA, Shaharuddin B, Razak NH. Hospital University Sains Malaysia experience in orbital floor reconstruction: autogenous graft versus Medpor. J Oral Maxillofac Durg 2011 Jun; 69(6): 1740-4.
17-Lieger O, Lizuka T. Use of Low profile titanium mesh in orbital reconstruction. J Craniofac Surg2011Apr; 43(1):71-3.
18-Piombino P, Spinzia A, Abbate V, Bonavolontà P, Orabona GD, Califano L. Reconstruction of small orbital floor fractures with resorbable collagen membranes. J Craniofac Surg 2013 Mar; 24(2): 571-4.
19-Bayat M, Momen  F, Khalilzadeh O, Mirhosseini Z, Sadeghi Tari A. Comparison of conchal cartilage graft with nasal septal cartilage graft for reconstruction of orbital floor blow out fractures. Br J of Maxillofac Surg 2010 Dec; 48(8): 617-20.
20-Xu JJ, Teng  L, Jin  XL, Ji  Y, Lu  JJ, Zhang  B. porous polyethylene implants in orbital blowout fx and enophthalmos reconstruction. J Craniofac Surg 2009 May; 20 (3): 918-20.
21-Ozturk S, Sengezer M, Isik S, Turegun M, Deveci M, Cil Y. Long term out comes of ultra- thin porous polyethylene implants used for reconstruction of orbital floor defects. J Craniofac Surg 2005 Nov; 16(6): 973-7.
22-Mintz Sm, Ettinger A, Schwakel T, Gleason MJ. Contralateral coronoid process bone grafts for orbital floor reconstruction: an anatomic and clinical study. J Oral Maxillofac Surg1998 Oct; 56 (10): 1140-5.
23-Kosaka M, Matsuzawa Y, Mori H, Matsuraga K, Kamiishi H. Orbital wall reconstruction with bone graft from the outer cortex of the mandible. J Oral Maxillofac Surg 2004 Dec; 32(6): 374-80.
24-Krishnan V, Johnson JV. Orbital floor reconstruction with autogenous mandibular symphyseal bone grafts. J Oral Maxillofac Surg1997 Apr; 55(4): 327-30.
25-Gungormus M, Yavus MS. The ascending ramus of the mandible as a donor site in maxillofacial bone grafting. J Oral Maxillofac Surg 2002Nov; 60(11):1316-18.
26-Fonseca RJ, Walker RV, Betts NJ, Barber HD, Powers MP. Oral and Maxillofacial Trauma. 3rd ed. St. Louis, MO: Saunders; 2005.
27-Gunarajab DR, Samman N. Biomaterials for repair of orbital floor blowout fractures: A systematic review. J Oral Maxillofac Surg 2013Mar; 71(3): 550-70.
28-Fonseca RJ, Barber HD, Walker RV, Powers MP.  Oral and Maxillofacial Trauma. 4th  ed. St. Louis, MO: Saunders; 2013.Vol.2. 875p.
 
 
 
 
 
Jundishapur Scientific Medical Journal
Volume 14, Issue 6 - Serial Number 99
January and February 2015
Pages 669-680

Files

History

  • Receive Date: 10 October 2014
  • Revise Date: 04 August 2015
  • Accept Date: 19 August 2015

Share

How to cite

Statistics